Provider Demographics
NPI:1598807596
Name:KIM, GON (LAC)
Entity Type:Individual
Prefix:
First Name:GON
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:GON
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:9806 SE CARR RD
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5813
Mailing Address - Country:US
Mailing Address - Phone:425-430-1336
Mailing Address - Fax:425-430-5583
Practice Address - Street 1:9806 SE CARR RD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5813
Practice Address - Country:US
Practice Address - Phone:425-430-1336
Practice Address - Fax:425-430-5583
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002784171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist