Provider Demographics
NPI:1245094705
Name:KIM, SO HYUN
Entity type:Individual
Prefix:
First Name:SO HYUN
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 1:1780 TOWN AND COUNTRY DR STE A102
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3617
Mailing Address - Country:US
Mailing Address - Phone:951-270-0036
Mailing Address - Fax:
Practice Address - Street 1:1780 TOWN AND COUNTRY DR STE A102
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3617
Practice Address - Country:US
Practice Address - Phone:951-270-0036
Practice Address - Fax:951-270-0023
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19754171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist