Provider Demographics
NPI:1245584804
Name:KIM, YOUNG KYU (AC)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:KYU
Last Name:KIM
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 WILSHIRE BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1206
Mailing Address - Country:US
Mailing Address - Phone:213-984-4541
Mailing Address - Fax:
Practice Address - Street 1:3130 WILSHIRE BLVD STE 308
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1206
Practice Address - Country:US
Practice Address - Phone:213-984-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11190171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist