Provider Demographics
NPI:1669651634
Name:KIM, CHANGOK (LAC,NCCAOMPHD)
Entity type:Individual
Prefix:DR
First Name:CHANGOK
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC,NCCAOMPHD
Other - Prefix:DR
Other - First Name:CHANGOK
Other - Middle Name:
Other - Last Name:GOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1230 W IMPERIAL HWY
Mailing Address - Street 2:STE# H
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6987
Mailing Address - Country:US
Mailing Address - Phone:562-697-1878
Mailing Address - Fax:562-309-8279
Practice Address - Street 1:1230 W IMPERIAL HWY
Practice Address - Street 2:STE# H
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6987
Practice Address - Country:US
Practice Address - Phone:562-697-1878
Practice Address - Fax:562-309-8279
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8450171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist