Provider Demographics
NPI:1578812269
Name:SRS KIM INC
Entity Type:Organization
Organization Name:SRS KIM INC
Other - Org Name:GOOD QI ACUPUNCTURE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:310-266-9760
Mailing Address - Street 1:5855 GREEN VALLEY CIRCLE.,
Mailing Address - Street 2:STE.201
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230
Mailing Address - Country:US
Mailing Address - Phone:310-266-9760
Mailing Address - Fax:310-670-1914
Practice Address - Street 1:12450 CULVER BLVD
Practice Address - Street 2:3305
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066
Practice Address - Country:US
Practice Address - Phone:310-266-9760
Practice Address - Fax:310-670-1914
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SRS KIM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10029171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134224447OtherPERSONAL NPI