Provider Demographics
NPI:1396901252
Name:KIM, HYEJIN (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:HYEJIN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 S BEACH BLVD STE P
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6386
Mailing Address - Country:US
Mailing Address - Phone:562-947-5729
Mailing Address - Fax:562-947-5739
Practice Address - Street 1:1251 S BEACH BLVD STE P
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6366
Practice Address - Country:US
Practice Address - Phone:562-947-5729
Practice Address - Fax:562-947-5739
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11805171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist