Provider Demographics
NPI:1437453891
Name:KIM, BOKYUN (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:BOKYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15508 S NORMANDIE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4014
Mailing Address - Country:US
Mailing Address - Phone:310-523-3747
Mailing Address - Fax:310-323-6470
Practice Address - Street 1:15508 S NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4014
Practice Address - Country:US
Practice Address - Phone:310-523-3747
Practice Address - Fax:310-323-6470
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7893171100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No174400000XOther Service ProvidersSpecialist