Provider Demographics
NPI:1235536673
Name:RHIM, SUNG MOON (LAC)
Entity Type:Individual
Prefix:
First Name:SUNG MOON
Middle Name:
Last Name:RHIM
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 1:3760 PEACOCK CT APT 11
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-4271
Mailing Address - Country:US
Mailing Address - Phone:408-781-3842
Mailing Address - Fax:
Practice Address - Street 1:3760 PEACOCK CT APT 11
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-4271
Practice Address - Country:US
Practice Address - Phone:408-781-3842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16347171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist