Provider Demographics
NPI:1295904423
Name:KIM, YOUNGSAM (LAC)
Entity type:Individual
Prefix:DR
First Name:YOUNGSAM
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 W D ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-2611
Mailing Address - Country:US
Mailing Address - Phone:559-924-5325
Mailing Address - Fax:
Practice Address - Street 1:449 W D ST
Practice Address - Street 2:SUITE C
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2611
Practice Address - Country:US
Practice Address - Phone:559-924-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11891171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist