Provider Demographics
NPI:1336406966
Name:KIM, MIN KYUN (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:MIN KYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 PASEO DEL NORTE STE 100
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1113
Mailing Address - Country:US
Mailing Address - Phone:619-309-6069
Mailing Address - Fax:619-550-0569
Practice Address - Street 1:6125 PASEO DEL NORTE STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1113
Practice Address - Country:US
Practice Address - Phone:619-309-6069
Practice Address - Fax:619-550-0569
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND854175F00000X
CAAC14637171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath