Provider Demographics
NPI:1629528690
Name:KIM, YONG SEOP
Entity Type:Individual
Prefix:
First Name:YONG SEOP
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 1:3545 WILSHIRE BLVD STE 327
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2388
Mailing Address - Country:US
Mailing Address - Phone:213-819-9199
Mailing Address - Fax:
Practice Address - Street 1:3545 WILSHIRE BLVD STE 327
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2388
Practice Address - Country:US
Practice Address - Phone:213-819-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11731171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist