Provider Demographics
NPI:1811376668
Name:KIM, JAEYOUNG (L AC)
Entity type:Individual
Prefix:
First Name:JAEYOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 ARTESIA BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3187
Mailing Address - Country:US
Mailing Address - Phone:425-412-0468
Mailing Address - Fax:
Practice Address - Street 1:2316 ARTESIA BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3187
Practice Address - Country:US
Practice Address - Phone:425-412-0468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16469171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist