Provider Demographics
NPI:1083176523
Name:KIM, YOUNG K (AC)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2018
Mailing Address - Country:US
Mailing Address - Phone:323-733-8814
Mailing Address - Fax:323-733-8817
Practice Address - Street 1:1027 4TH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2018
Practice Address - Country:US
Practice Address - Phone:323-733-8814
Practice Address - Fax:323-733-8817
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14128171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist