Provider Demographics
NPI:1295084861
Name:KIM, KIYOUNG (DAOM)
Entity type:Individual
Prefix:DR
First Name:KIYOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801221
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91380-1221
Mailing Address - Country:US
Mailing Address - Phone:323-286-2635
Mailing Address - Fax:
Practice Address - Street 1:27734 AVENUE SCOTT STE 110
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3423
Practice Address - Country:US
Practice Address - Phone:323-286-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA11114171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist