Provider Demographics
NPI:1346976180
Name:KIM, IRENE HYE SOOK
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:HYE SOOK
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23332 HAWTHORNE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3766
Mailing Address - Country:US
Mailing Address - Phone:424-437-9096
Mailing Address - Fax:
Practice Address - Street 1:23332 HAWTHORNE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3766
Practice Address - Country:US
Practice Address - Phone:424-437-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWL2757171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty