Provider Demographics
NPI:1336611938
Name:KIM, YOUNG HO (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:HO
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2966 WILSHIRE BLVD # A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1128
Mailing Address - Country:US
Mailing Address - Phone:213-487-3133
Mailing Address - Fax:213-487-3233
Practice Address - Street 1:2966 WILSHIRE BLVD # A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1128
Practice Address - Country:US
Practice Address - Phone:213-487-3133
Practice Address - Fax:213-487-3233
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7894171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist