Provider Demographics
NPI:1790120350
Name:KIM, CHRISTIAN K
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1771
Mailing Address - Country:US
Mailing Address - Phone:650-730-3727
Mailing Address - Fax:650-369-3727
Practice Address - Street 1:77 BIRCH ST
Practice Address - Street 2:SUITE B
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1423
Practice Address - Country:US
Practice Address - Phone:650-730-3727
Practice Address - Fax:650-369-3727
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15296171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist