Provider Demographics
NPI:1598308231
Name:KWAK, KIL YOUNG (LAC)
Entity Type:Individual
Prefix:
First Name:KIL YOUNG
Middle Name:
Last Name:KWAK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W OLYMPIC BLVD # 207
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2122
Mailing Address - Country:US
Mailing Address - Phone:213-365-2277
Mailing Address - Fax:213-385-3710
Practice Address - Street 1:3400 W OLYMPIC BLVD # 207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2122
Practice Address - Country:US
Practice Address - Phone:213-365-2277
Practice Address - Fax:213-385-3710
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13475171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist