Provider Demographics
NPI:1730457623
Name:KIM, EUN A (MSAOM)
Entity Type:Individual
Prefix:MRS
First Name:EUN A
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MSAOM
Other - Prefix:MRS
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSAOM
Mailing Address - Street 1:19862 CALLE GRANADA
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1708
Mailing Address - Country:US
Mailing Address - Phone:909-569-2427
Mailing Address - Fax:
Practice Address - Street 1:8730 SANTA MONICA BLVD
Practice Address - Street 2:#E
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4547
Practice Address - Country:US
Practice Address - Phone:310-652-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14327171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist