Provider Demographics
NPI:1598066805
Name:KIM, SANG W (LAC)
Entity Type:Individual
Prefix:MR
First Name:SANG
Middle Name:W
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:140 LITTLE FALLS ST
Mailing Address - Street 2:105
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4323
Mailing Address - Country:US
Mailing Address - Phone:703-888-7081
Mailing Address - Fax:703-538-6899
Practice Address - Street 1:140 LITTLE FALLS ST
Practice Address - Street 2:105
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4323
Practice Address - Country:US
Practice Address - Phone:703-888-7081
Practice Address - Fax:703-538-6899
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0121000537171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist