Provider Demographics
NPI:1386857480
Name:KIM, PATRICIA (ND, MSOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:ND, MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1969 N ALEXANDRIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1742
Mailing Address - Country:US
Mailing Address - Phone:562-760-2162
Mailing Address - Fax:
Practice Address - Street 1:1357 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-7608
Practice Address - Country:US
Practice Address - Phone:323-988-4051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10051171100000X
CAND 55175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath