Provider Demographics
NPI:1831323054
Name:KIM, GHIL EUNG (LAC)
Entity Type:Individual
Prefix:
First Name:GHIL
Middle Name:EUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6771 BEACH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3470
Mailing Address - Country:US
Mailing Address - Phone:714-522-0175
Mailing Address - Fax:714-522-0175
Practice Address - Street 1:6771 BEACH BLVD STE B
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3470
Practice Address - Country:US
Practice Address - Phone:714-522-0175
Practice Address - Fax:714-522-0175
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6698171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist