Provider Demographics
NPI:1164634648
Name:KIM, KYUNG AE (LAC)
Entity Type:Individual
Prefix:
First Name:KYUNG
Middle Name:AE
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S ARDMORE AVE
Mailing Address - Street 2:STE 354
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3330
Mailing Address - Country:US
Mailing Address - Phone:213-820-3181
Mailing Address - Fax:
Practice Address - Street 1:356 S WESTERN AVE
Practice Address - Street 2:STE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3805
Practice Address - Country:US
Practice Address - Phone:213-384-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10308171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist