Provider Demographics
NPI:1134566318
Name:KIM, ILWHA
Entity type:Individual
Prefix:MS
First Name:ILWHA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WATERWORKS WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3176
Mailing Address - Country:US
Mailing Address - Phone:949-390-6480
Mailing Address - Fax:714-870-5028
Practice Address - Street 1:113 WATERWORKS WAY STE 205
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3176
Practice Address - Country:US
Practice Address - Phone:949-390-6480
Practice Address - Fax:714-870-5028
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16114171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist