Provider Demographics
NPI:1508047192
Name:KIM, TAE SUN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TAE SUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5156
Mailing Address - Country:US
Mailing Address - Phone:714-533-3370
Mailing Address - Fax:
Practice Address - Street 1:866 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5156
Practice Address - Country:US
Practice Address - Phone:714-533-3370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-24
Last Update Date:2007-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5880171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist