Provider Demographics
NPI:1063864106
Name:KI ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:KI ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HYON SOG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:661-251-5930
Mailing Address - Street 1:18261 SOLEDAD CANYON ROAD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387
Mailing Address - Country:US
Mailing Address - Phone:661-251-5930
Mailing Address - Fax:
Practice Address - Street 1:18261 SOLEDAD CANYON ROAD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387
Practice Address - Country:US
Practice Address - Phone:661-251-5930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10210171100000X
CA171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty