Provider Demographics
NPI:1558709808
Name:KIM, YONG OOK (LAC)
Entity Type:Individual
Prefix:MR
First Name:YONG OOK
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 1:6301 BEACH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-4030
Mailing Address - Country:US
Mailing Address - Phone:714-522-2100
Mailing Address - Fax:
Practice Address - Street 1:6301 BEACH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4030
Practice Address - Country:US
Practice Address - Phone:714-522-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11787171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist