Provider Demographics
NPI:1598184749
Name:KIM, HYUN
Entity Type:Individual
Prefix:
First Name:HYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 FAIRESTA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2616
Mailing Address - Country:US
Mailing Address - Phone:714-791-9307
Mailing Address - Fax:
Practice Address - Street 1:3407 W 6TH ST
Practice Address - Street 2:#827
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2537
Practice Address - Country:US
Practice Address - Phone:714-791-9307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7419171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist