Provider Demographics
NPI:1609157205
Name:KIM, JAMES INKYU (L AC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:INKYU
Last Name:KIM
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 S NEW HAMPSHIRE AVE
Mailing Address - Street 2:120
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1950
Mailing Address - Country:US
Mailing Address - Phone:213-840-3094
Mailing Address - Fax:
Practice Address - Street 1:415 N EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-6706
Practice Address - Country:US
Practice Address - Phone:949-361-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10835171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist