Provider Demographics
NPI:1144395666
Name:KIM, EUNAE (ACUPUNCTURIST)
Entity Type:Individual
Prefix:PROF
First Name:EUNAE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:EUNAE
Other - Middle Name:GRACE
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACUPUNCTURIST
Mailing Address - Street 1:5205 BELMORE MANOR CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4338
Mailing Address - Country:US
Mailing Address - Phone:714-814-2580
Mailing Address - Fax:
Practice Address - Street 1:1605 BUFORD HWY STE R
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8832
Practice Address - Country:US
Practice Address - Phone:470-333-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA369171100000X
CA10208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA0102080OtherBLUE SHIELD OF CALIFORNIA