Provider Demographics
NPI:1437244548
Name:KIM, SIMON C (L AC)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
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Mailing Address - Street 1:3439 CLIPPER DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3621
Mailing Address - Country:US
Mailing Address - Phone:213-268-8323
Mailing Address - Fax:714-525-1312
Practice Address - Street 1:115 E COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1907
Practice Address - Country:US
Practice Address - Phone:714-525-0452
Practice Address - Fax:714-525-1312
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC10615171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist