Provider Demographics
NPI:1568534006
Name:KIM, EUN SANG SANG
Entity Type:Individual
Prefix:MR
First Name:EUN SANG
Middle Name:SANG
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:EUN
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:951 S WESTLAKE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-371-0058
Mailing Address - Fax:805-371-0058
Practice Address - Street 1:951 S WESTLAKE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:805-371-0058
Practice Address - Fax:805-371-0058
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9341171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist