Provider Demographics
NPI:1790360089
Name:KEN'S ACPUNCTURE & WELLNESS, INC
Entity Type:Organization
Organization Name:KEN'S ACPUNCTURE & WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG WOO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:818-966-0653
Mailing Address - Street 1:1535 GRANVILLE AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2863
Mailing Address - Country:US
Mailing Address - Phone:213-298-8853
Mailing Address - Fax:818-561-3752
Practice Address - Street 1:10605 BALBOA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6365
Practice Address - Country:US
Practice Address - Phone:818-966-0653
Practice Address - Fax:818-561-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty