Provider Demographics
NPI:1891813754
Name:KIM, WON (LAC)
Entity Type:Individual
Prefix:
First Name:WON
Middle Name:
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 1:1150 YALE ST
Mailing Address - Street 2:7
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4738
Mailing Address - Country:US
Mailing Address - Phone:310-804-8269
Mailing Address - Fax:310-392-1132
Practice Address - Street 1:1150 YALE ST
Practice Address - Street 2:7
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4738
Practice Address - Country:US
Practice Address - Phone:310-804-8269
Practice Address - Fax:310-392-1132
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10525171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist