Provider Demographics
NPI:1952735409
Name:KIM, AYOUNG (LAC)
Entity Type:Individual
Prefix:MS
First Name:AYOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 NICKLAS LN
Mailing Address - Street 2:APT 3B
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-3253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15690 LOS GATOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2504
Practice Address - Country:US
Practice Address - Phone:408-386-3115
Practice Address - Fax:408-356-7558
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist