Provider Demographics
NPI:1881810463
Name:SUN, KI HOON (AC)
Entity type:Individual
Prefix:DR
First Name:KI
Middle Name:HOON
Last Name:SUN
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10338 1/2 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3437
Mailing Address - Country:US
Mailing Address - Phone:818-363-2354
Mailing Address - Fax:818-363-4580
Practice Address - Street 1:10338 1/2 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-3437
Practice Address - Country:US
Practice Address - Phone:818-363-2354
Practice Address - Fax:818-363-4580
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5234171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0052340Medicaid