Provider Demographics
NPI:1750632055
Name:KIM, YOUNG KI
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:KI
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5432 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504
Mailing Address - Country:US
Mailing Address - Phone:951-703-5282
Mailing Address - Fax:951-299-8598
Practice Address - Street 1:5432 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2505
Practice Address - Country:US
Practice Address - Phone:951-703-5282
Practice Address - Fax:951-299-8598
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14813171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist