Provider Demographics
NPI:1275802076
Name:KIM, SANG YOP (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:YOP
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 SARATOGA AVE
Mailing Address - Street 2:BLDG2 SUITE 6
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6612
Mailing Address - Country:US
Mailing Address - Phone:408-871-5990
Mailing Address - Fax:
Practice Address - Street 1:1848 SARATOGA AVE
Practice Address - Street 2:BLDG2 SUITE 6
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6612
Practice Address - Country:US
Practice Address - Phone:408-871-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13994171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist