Provider Demographics
NPI:1255587333
Name:KIM, SEHGON ABE (LAC)
Entity type:Individual
Prefix:
First Name:SEHGON
Middle Name:ABE
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:530 LOMAS SANTA FE DR
Mailing Address - Street 2:SUITE B1
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1349
Mailing Address - Country:US
Mailing Address - Phone:858-755-5777
Mailing Address - Fax:858-481-1433
Practice Address - Street 1:530 LOMAS SANTA FE DR
Practice Address - Street 2:SUITE B1
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1349
Practice Address - Country:US
Practice Address - Phone:858-755-5777
Practice Address - Fax:858-481-1433
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC 12096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist