Provider Demographics
NPI:1629300405
Name:KIM, HEE CHUL
Entity Type:Individual
Prefix:
First Name:HEE CHUL
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 1:505 S VIRGIL AVE
Mailing Address - Street 2:#140
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1406
Mailing Address - Country:US
Mailing Address - Phone:213-200-0882
Mailing Address - Fax:213-388-0602
Practice Address - Street 1:505 S VIRGIL AVE
Practice Address - Street 2:#140
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1406
Practice Address - Country:US
Practice Address - Phone:213-200-0882
Practice Address - Fax:213-388-0602
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12503171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist