Provider Demographics
NPI:1760917009
Name:KIM, HAN NA
Entity Type:Individual
Prefix:
First Name:HAN NA
Middle Name:
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 1:12587 CARSON ST
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-1667
Mailing Address - Country:US
Mailing Address - Phone:562-809-8626
Mailing Address - Fax:562-865-8957
Practice Address - Street 1:12587 CARSON ST
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-1667
Practice Address - Country:US
Practice Address - Phone:562-809-8626
Practice Address - Fax:562-865-8957
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15604171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist