Provider Demographics
NPI:1548390073
Name:KIM, YOOSOON (LAC)
Entity Type:Individual
Prefix:MRS
First Name:YOOSOON
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5527 BURNING TREE DR
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2860
Mailing Address - Country:US
Mailing Address - Phone:818-952-5075
Mailing Address - Fax:323-933-8815
Practice Address - Street 1:4160 WILSHIRE BLVD
Practice Address - Street 2:SUITE NO 301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3569
Practice Address - Country:US
Practice Address - Phone:323-933-8814
Practice Address - Fax:323-933-8815
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7803171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist