Provider Demographics
NPI:1851510010
Name:UM, TAE KYUNG (LAC)
Entity Type:Individual
Prefix:MRS
First Name:TAE
Middle Name:KYUNG
Last Name:UM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6019 NILES ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-4649
Mailing Address - Country:US
Mailing Address - Phone:661-363-0737
Mailing Address - Fax:661-363-5476
Practice Address - Street 1:6019 NILES ST. STE. # 4
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306
Practice Address - Country:US
Practice Address - Phone:661-363-0737
Practice Address - Fax:661-363-5476
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5274171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist