Provider Demographics
NPI:1770638058
Name:KIM, JAMES K (LIC AC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11353 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3151
Mailing Address - Country:US
Mailing Address - Phone:310-996-7778
Mailing Address - Fax:310-996-7773
Practice Address - Street 1:11353 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3151
Practice Address - Country:US
Practice Address - Phone:310-996-7778
Practice Address - Fax:310-996-7773
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9054171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist