Provider Demographics
NPI:1659738417
Name:KIM, HYUN SOOK (L AC)
Entity Type:Individual
Prefix:
First Name:HYUN
Middle Name:SOOK
Last Name:KIM
Suffix:
Gender:F
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 1:406 S ST ANDREWS PL APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4372
Mailing Address - Country:US
Mailing Address - Phone:213-422-4555
Mailing Address - Fax:
Practice Address - Street 1:1045 S WESTERN AVE STE C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2382
Practice Address - Country:US
Practice Address - Phone:213-422-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3358171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist