Provider Demographics
NPI:1679845986
Name:KIM, KYU HWAN (AC)
Entity Type:Individual
Prefix:DR
First Name:KYU
Middle Name:HWAN
Last Name:KIM
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7223 CHURCH ST STE A1
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5811
Mailing Address - Country:US
Mailing Address - Phone:909-863-7597
Mailing Address - Fax:818-366-7078
Practice Address - Street 1:7223 CHURCH ST STE A1
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5811
Practice Address - Country:US
Practice Address - Phone:909-863-7597
Practice Address - Fax:818-366-7078
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12149171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist