Provider Demographics
NPI:1700322062
Name:KIM, EUN HEE (LAC)
Entity Type:Individual
Prefix:
First Name:EUN HEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 EL CAMINO REAL STE 9
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-2871
Mailing Address - Country:US
Mailing Address - Phone:650-771-7254
Mailing Address - Fax:
Practice Address - Street 1:200 S BEACH BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5180
Practice Address - Country:US
Practice Address - Phone:714-261-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13525171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 13525OtherCA LICENSED ACUPUNCTURIST