Provider Demographics
NPI:1437303021
Name:KIM, HEE S (LAC)
Entity Type:Individual
Prefix:
First Name:HEE
Middle Name:S
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3733 ROSEMEAD BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1981
Mailing Address - Country:US
Mailing Address - Phone:626-307-1003
Mailing Address - Fax:626-307-1056
Practice Address - Street 1:3733 ROSEMEAD BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1981
Practice Address - Country:US
Practice Address - Phone:626-307-1003
Practice Address - Fax:626-307-1056
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10601171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist