Provider Demographics
NPI:1245392869
Name:KIM, YOUNGIN (ACUPUNCTURE)
Entity Type:Individual
Prefix:
First Name:YOUNGIN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 W COLLEGE ST APT 207
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-5927
Mailing Address - Country:US
Mailing Address - Phone:213-618-1474
Mailing Address - Fax:
Practice Address - Street 1:2621 W OLYMPIC BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2878
Practice Address - Country:US
Practice Address - Phone:213-382-0060
Practice Address - Fax:213-382-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist