Provider Demographics
NPI:1245584804
Name:KIM, YOUNG KYU (AC)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:KYU
Last Name:KIM
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 SCOTT BLVD
Mailing Address - Street 2:#109
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-1206
Mailing Address - Country:US
Mailing Address - Phone:408-823-9962
Mailing Address - Fax:669-333-3220
Practice Address - Street 1:1765 SCOTT BLVD
Practice Address - Street 2:# 109
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-1206
Practice Address - Country:US
Practice Address - Phone:408-823-9962
Practice Address - Fax:669-333-3220
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11190171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist