Provider Demographics
NPI:1013728625
Name:KIM, MYUNCHEOL
Entity type:Individual
Prefix:
First Name:MYUNCHEOL
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 1:2015 W REDONDO BEACH BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3642
Mailing Address - Country:US
Mailing Address - Phone:424-340-9357
Mailing Address - Fax:424-340-2467
Practice Address - Street 1:2015 W REDONDO BEACH BLVD STE F
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3642
Practice Address - Country:US
Practice Address - Phone:424-340-9357
Practice Address - Fax:424-340-2467
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
CA19447171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist