Provider Demographics
NPI:1306841028
Name:KIM, KIMMY H (ACUPUNCTURUST)
Entity Type:Individual
Prefix:DR
First Name:KIMMY
Middle Name:H
Last Name:KIM
Suffix:
Gender:F
Credentials:ACUPUNCTURUST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 BEVERLY BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-4429
Mailing Address - Country:US
Mailing Address - Phone:213-738-7447
Mailing Address - Fax:
Practice Address - Street 1:4214 BEVERLY BLVD
Practice Address - Street 2:STE 210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4429
Practice Address - Country:US
Practice Address - Phone:213-738-7447
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC5629171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist