Provider Demographics
NPI:1720661846
Name:KIM, MYOJIN HA
Entity Type:Individual
Prefix:MRS
First Name:MYOJIN
Middle Name:HA
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S. BEACH BLVD.,
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-9700
Mailing Address - Country:US
Mailing Address - Phone:562-902-1010
Mailing Address - Fax:800-650-9114
Practice Address - Street 1:1201 S. BEACH BLVD.,
Practice Address - Street 2:SUITE 102
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-9700
Practice Address - Country:US
Practice Address - Phone:562-902-1010
Practice Address - Fax:800-650-9114
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19104171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist