Provider Demographics
NPI:1740344530
Name:KIM, BRUCE (LAC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2911 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-4303
Mailing Address - Country:US
Mailing Address - Phone:972-245-1672
Mailing Address - Fax:
Practice Address - Street 1:2840 KELLER SPRINGS RD
Practice Address - Street 2:SUITE #102
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-4829
Practice Address - Country:US
Practice Address - Phone:972-418-1776
Practice Address - Fax:972-418-1779
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00662171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist