Provider Demographics
NPI:1457592198
Name:ISD ACUPUNCTURE & HERBAL CLINIC
Entity Type:Organization
Organization Name:ISD ACUPUNCTURE & HERBAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:HYO-KYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:253-588-4800
Mailing Address - Street 1:9122 SOUTH TACOMA WAY
Mailing Address - Street 2:#110
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499
Mailing Address - Country:US
Mailing Address - Phone:253-588-4800
Mailing Address - Fax:253-588-5808
Practice Address - Street 1:9122 SOUTH TACOMA WAY
Practice Address - Street 2:#110
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-588-4800
Practice Address - Fax:253-588-5808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISD ACUPUNCTURE & HERBAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC2345171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty