Provider Demographics
NPI:1801032255
Name:KIM, HYUN CHUNG (LAC)
Entity Type:Individual
Prefix:
First Name:HYUN
Middle Name:CHUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 OVERLAND AVE APT 6107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4515
Mailing Address - Country:US
Mailing Address - Phone:310-463-6100
Mailing Address - Fax:
Practice Address - Street 1:3217 OVERLAND AVE APT 6107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-4515
Practice Address - Country:US
Practice Address - Phone:310-463-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12583171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780820134OtherACUPUNCTURIST