Provider Demographics
NPI:1962004762
Name:KIM, HYUN JOO (LAC)
Entity Type:Individual
Prefix:
First Name:HYUN JOO
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12362 BEACH BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-3944
Mailing Address - Country:US
Mailing Address - Phone:714-248-9500
Mailing Address - Fax:714-622-4943
Practice Address - Street 1:12362 BEACH BLVD STE 10
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3944
Practice Address - Country:US
Practice Address - Phone:714-248-9500
Practice Address - Fax:714-622-4943
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18974171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist