Provider Demographics
NPI:1265629257
Name:KIM, CHEL (LAC)
Entity Type:Individual
Prefix:
First Name:CHEL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1400 N HARBOR BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4110
Mailing Address - Country:US
Mailing Address - Phone:714-773-7000
Mailing Address - Fax:714-870-5028
Practice Address - Street 1:1400 N HARBOR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4110
Practice Address - Country:US
Practice Address - Phone:714-773-7000
Practice Address - Fax:714-870-5028
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC11202171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist