Provider Demographics
NPI:1205978038
Name:KIM, YOUNG SOO (LAC, PHD)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:SOO
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:YOUNG
Other - Middle Name:S
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:20278 PASEO LORENZO
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-5710
Mailing Address - Country:US
Mailing Address - Phone:714-970-1020
Mailing Address - Fax:
Practice Address - Street 1:1915 W 1ST ST STE D
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3564
Practice Address - Country:US
Practice Address - Phone:714-541-6654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC. 11026171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist