Provider Demographics
NPI:1477209559
Name:KIM, INKI
Entity Type:Individual
Prefix:
First Name:INKI
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11419 19TH AVE SE STE C106
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5120
Mailing Address - Country:US
Mailing Address - Phone:425-523-8878
Mailing Address - Fax:425-523-8868
Practice Address - Street 1:11419 19TH AVE SE STE C106
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5120
Practice Address - Country:US
Practice Address - Phone:425-523-8878
Practice Address - Fax:425-523-8868
Is Sole Proprietor?:No
Enumeration Date:2022-02-26
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60073357171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist