Provider Demographics
NPI:1043345630
Name:KIM, NAM HYOUNG (LAC, OMD)
Entity Type:Individual
Prefix:DR
First Name:NAM
Middle Name:HYOUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15225 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3823
Mailing Address - Country:US
Mailing Address - Phone:425-643-3999
Mailing Address - Fax:425-643-2619
Practice Address - Street 1:15225 NE 20TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3823
Practice Address - Country:US
Practice Address - Phone:425-643-3999
Practice Address - Fax:425-643-2619
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist