Provider Demographics
NPI:1952832578
Name:KEN'S ACUPUNCTURE & WELLNESS
Entity Type:Organization
Organization Name:KEN'S ACUPUNCTURE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANG WOO
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:CA LICENSE
Authorized Official - Phone:213-298-8853
Mailing Address - Street 1:1535 GRANVILLE AVE APT 108
Mailing Address - Street 2:108
Mailing Address - City:WEST LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2863
Mailing Address - Country:US
Mailing Address - Phone:213-298-8853
Mailing Address - Fax:818-561-3752
Practice Address - Street 1:7355 LANKERSHIM BLVD # 12A
Practice Address - Street 2:12A
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-3847
Practice Address - Country:US
Practice Address - Phone:213-298-8853
Practice Address - Fax:818-561-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACABO 14911171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty