Provider Demographics
NPI:1568693042
Name:KIM, SAI-KYOUNG IRENE (OMD, LAC)
Entity Type:Individual
Prefix:DR
First Name:SAI-KYOUNG
Middle Name:IRENE
Last Name:KIM
Suffix:
Gender:F
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11645 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 825
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1708
Mailing Address - Country:US
Mailing Address - Phone:310-207-3320
Mailing Address - Fax:310-820-5868
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:SUITE 825
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1708
Practice Address - Country:US
Practice Address - Phone:310-207-3320
Practice Address - Fax:310-820-5868
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-02
Last Update Date:2009-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9683171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist