Provider Demographics
NPI:1831442037
Name:KIM, BU WON (LAC)
Entity type:Individual
Prefix:MR
First Name:BU
Middle Name:WON
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:WON
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:308 S OXFORD AVE
Mailing Address - Street 2:LOS ANGELES
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3849
Mailing Address - Country:US
Mailing Address - Phone:213-239-4189
Mailing Address - Fax:
Practice Address - Street 1:1200 WILSHIRE BLVD STE 308
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1930
Practice Address - Country:US
Practice Address - Phone:213-239-4189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9495171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist