Provider Demographics
NPI:1043359482
Name:KIM, JAE SEUNG (LAC, PHD)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:SEUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3400 W OLYMPIC BL
Mailing Address - Street 2:STE207
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2122
Mailing Address - Country:US
Mailing Address - Phone:213-365-2277
Mailing Address - Fax:213-385-3710
Practice Address - Street 1:3400 W OLYMPIC BL
Practice Address - Street 2:STE207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2122
Practice Address - Country:US
Practice Address - Phone:213-365-2277
Practice Address - Fax:213-385-3710
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4989171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist