Provider Demographics
NPI:1205000692
Name:KIM, YONG SUNG (LAC)
Entity Type:Individual
Prefix:MR
First Name:YONG
Middle Name:SUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E BEVERLY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3799
Mailing Address - Country:US
Mailing Address - Phone:323-726-1947
Mailing Address - Fax:
Practice Address - Street 1:249 E. BEVERLY BLVD., #B
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4752
Practice Address - Country:US
Practice Address - Phone:323-726-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12375171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist