Provider Demographics
NPI:1982122149
Name:KIM, KWANGSOON (L AC)
Entity Type:Individual
Prefix:MRS
First Name:KWANGSOON
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W 6TH ST STE 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-2576
Mailing Address - Country:US
Mailing Address - Phone:213-598-6117
Mailing Address - Fax:213-478-0960
Practice Address - Street 1:3400 W 6TH ST STE 305
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2576
Practice Address - Country:US
Practice Address - Phone:213-598-6117
Practice Address - Fax:213-478-0960
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty