Provider Demographics
NPI:1326313875
Name:KIM, YOUNG MAN (DOM, PHD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG MAN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DOM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S LA FAYETTE PARK PL
Mailing Address - Street 2:550
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1607
Mailing Address - Country:US
Mailing Address - Phone:213-386-0702
Mailing Address - Fax:
Practice Address - Street 1:520 S LA FAYETTE PARK PL
Practice Address - Street 2:550
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1607
Practice Address - Country:US
Practice Address - Phone:213-386-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5968171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist