Provider Demographics
NPI:1023018603
Name:KIM-HAMMERICH, LUMIEL (LAC)
Entity Type:Individual
Prefix:MRS
First Name:LUMIEL
Middle Name:
Last Name:KIM-HAMMERICH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LUMIEL
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1299 4TH ST
Mailing Address - Street 2:SUITE 509
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3040
Mailing Address - Country:US
Mailing Address - Phone:415-302-8507
Mailing Address - Fax:415-485-6221
Practice Address - Street 1:1299 4TH ST
Practice Address - Street 2:SUITE 509
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3040
Practice Address - Country:US
Practice Address - Phone:415-302-8507
Practice Address - Fax:415-485-6221
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist