Provider Demographics
NPI:1760536940
Name:KIM, PYO Y (LAC)
Entity Type:Individual
Prefix:
First Name:PYO
Middle Name:Y
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:P
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:1830 COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2230
Mailing Address - Country:US
Mailing Address - Phone:805-578-9191
Mailing Address - Fax:805-578-9191
Practice Address - Street 1:1830 COCHRAN ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2230
Practice Address - Country:US
Practice Address - Phone:805-578-9191
Practice Address - Fax:805-578-9191
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9107171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist