Provider Demographics
NPI:1275923344
Name:KIM, ANGELINA (LICENSED ACUPUNCTURE)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LICENSED ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 S STOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3317
Mailing Address - Country:US
Mailing Address - Phone:608-825-1500
Mailing Address - Fax:
Practice Address - Street 1:2623 S STOUGHTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-3317
Practice Address - Country:US
Practice Address - Phone:608-825-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist