Provider Demographics
NPI:1851433882
Name:KIM, KI H (MS, LAC)
Entity Type:Individual
Prefix:MR
First Name:KI
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 WILSHIRE BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1120
Mailing Address - Country:US
Mailing Address - Phone:213-924-6079
Mailing Address - Fax:844-734-0427
Practice Address - Street 1:3020 WILSHIRE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1120
Practice Address - Country:US
Practice Address - Phone:213-924-6079
Practice Address - Fax:844-734-0427
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11034171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA212799962Medicaid