Provider Demographics
NPI:1831275932
Name:CUI, KATHLYN KEXIN (OMD)
Entity type:Individual
Prefix:MS
First Name:KATHLYN
Middle Name:KEXIN
Last Name:CUI
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:MS
Other - First Name:KEXIN
Other - Middle Name:
Other - Last Name:CUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1630 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-5205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:195 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6019
Practice Address - Country:US
Practice Address - Phone:909-946-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7311171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist