Provider Demographics
NPI:1659810786
Name:KIM'S ACUPUNCTURE, INC
Entity Type:Organization
Organization Name:KIM'S ACUPUNCTURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:MEE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:818-809-1009
Mailing Address - Street 1:18500 MAYALL ST
Mailing Address - Street 2:H
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-1461
Mailing Address - Country:US
Mailing Address - Phone:818-486-9496
Mailing Address - Fax:
Practice Address - Street 1:16250 VENTURA BLVD
Practice Address - Street 2:STE 450
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2204
Practice Address - Country:US
Practice Address - Phone:818-809-1009
Practice Address - Fax:818-809-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC 17165171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty