Provider Demographics
NPI:1952481020
Name:KIM, SPENCER WOO (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:WOO
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:SPENCER
Other - Middle Name:WOO
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACUPUNCTURIST
Mailing Address - Street 1:375 E 2ND ST
Mailing Address - Street 2:#307
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4239
Mailing Address - Country:US
Mailing Address - Phone:213-884-2090
Mailing Address - Fax:213-221-4719
Practice Address - Street 1:3440 WILSHIRE BLVD
Practice Address - Street 2:SUITE #280
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2101
Practice Address - Country:US
Practice Address - Phone:213-884-2090
Practice Address - Fax:213-221-4719
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7994171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist