Provider Demographics
NPI:1609309087
Name:SARAH LEE KIM ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:SARAH LEE KIM ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:714-321-2273
Mailing Address - Street 1:390 N SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 1140
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:390 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 1140
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4475
Practice Address - Country:US
Practice Address - Phone:714-321-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12865405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty