Provider Demographics
NPI:1407593064
Name:KIM, SONGHYUN (LAC)
Entity Type:Individual
Prefix:
First Name:SONGHYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 S FULLER AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5459
Mailing Address - Country:US
Mailing Address - Phone:808-428-6828
Mailing Address - Fax:
Practice Address - Street 1:4400 COLDWATER CANYON AVE STE 320
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-5043
Practice Address - Country:US
Practice Address - Phone:818-818-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19461171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist