Provider Demographics
NPI:1609409630
Name:KIM, TEAHO
Entity Type:Individual
Prefix:
First Name:TEAHO
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 1:329 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3804
Mailing Address - Country:US
Mailing Address - Phone:213-880-2100
Mailing Address - Fax:213-388-7676
Practice Address - Street 1:329 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3804
Practice Address - Country:US
Practice Address - Phone:213-880-2100
Practice Address - Fax:213-388-7676
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist