Provider Demographics
NPI:1366562639
Name:KIM, KWANG HUN (ACUPUNCTURIST)
Entity type:Individual
Prefix:MR
First Name:KWANG
Middle Name:HUN
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 W 6TH ST STE 316
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-5805
Mailing Address - Country:US
Mailing Address - Phone:213-908-6257
Mailing Address - Fax:
Practice Address - Street 1:3500 W 6TH ST STE 316
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5805
Practice Address - Country:US
Practice Address - Phone:213-908-6257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11537171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist