Provider Demographics
NPI:1447582903
Name:KIM, JINYOUNG (LAC)
Entity Type:Individual
Prefix:MR
First Name:JINYOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S. WESTERN AVE #208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036
Mailing Address - Country:US
Mailing Address - Phone:213-260-1001
Mailing Address - Fax:323-208-4812
Practice Address - Street 1:730 S WESTERN AVE STE 208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-5901
Practice Address - Country:US
Practice Address - Phone:213-260-1001
Practice Address - Fax:323-208-4812
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13069171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist