Provider Demographics
NPI:1891927364
Name:KIM, SANGJUN
Entity Type:Individual
Prefix:
First Name:SANGJUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7940 ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3437
Mailing Address - Country:US
Mailing Address - Phone:714-515-0607
Mailing Address - Fax:714-736-0084
Practice Address - Street 1:7940 ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3437
Practice Address - Country:US
Practice Address - Phone:714-515-0607
Practice Address - Fax:714-736-0084
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 17293171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist