Provider Demographics
NPI:1467808774
Name:KIM, ALEXANDER HYUN (LAC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:HYUN
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 1:22226 6TH AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6244
Mailing Address - Country:US
Mailing Address - Phone:206-643-9786
Mailing Address - Fax:206-870-0888
Practice Address - Street 1:22226 6TH AVE S STE 101
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6244
Practice Address - Country:US
Practice Address - Phone:206-643-9786
Practice Address - Fax:206-870-0888
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60646289171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA87-4212298OtherIRS