Provider Demographics
NPI:1184781619
Name:KIM, CHAN HYUN (LICENSED ACUPUNCTURI)
Entity type:Individual
Prefix:
First Name:CHAN
Middle Name:HYUN
Last Name:KIM
Suffix:
Gender:M
Credentials:LICENSED ACUPUNCTURI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 E THOUSAND OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:61360-6009
Mailing Address - Country:US
Mailing Address - Phone:805-497-7631
Mailing Address - Fax:805-497-7631
Practice Address - Street 1:650 E THOUSAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:61360-6009
Practice Address - Country:US
Practice Address - Phone:805-497-7631
Practice Address - Fax:805-497-7631
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8064171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist