Provider Demographics
NPI:1417183765
Name:KIM, YOUNG UK (LAC)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:UK
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:621 S . VIRGIL AVE
Mailing Address - Street 2:#310
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-4047
Mailing Address - Country:US
Mailing Address - Phone:213-382-5556
Mailing Address - Fax:213-382-5575
Practice Address - Street 1:621 S VIRGIL AVE
Practice Address - Street 2:#310
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-4000
Practice Address - Country:US
Practice Address - Phone:213-382-5556
Practice Address - Fax:213-382-5575
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist