Provider Demographics
NPI:1477004323
Name:KIM, EUN YOUNG
Entity Type:Individual
Prefix:
First Name:EUN YOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14785 JEFFREY RD STE 109
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0410
Mailing Address - Country:US
Mailing Address - Phone:949-559-3675
Mailing Address - Fax:949-336-1423
Practice Address - Street 1:14785 JEFFREY RD STE 109
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0410
Practice Address - Country:US
Practice Address - Phone:949-559-3675
Practice Address - Fax:949-336-1423
Is Sole Proprietor?:No
Enumeration Date:2016-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17362171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist