Provider Demographics
NPI:1669927711
Name:KIM, HOWARD SUNGJI (ACUPUNCTURE)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:SUNGJI
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 W 6TH ST # 207
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1522
Mailing Address - Country:US
Mailing Address - Phone:714-494-3009
Mailing Address - Fax:
Practice Address - Street 1:3000 W. 6TH
Practice Address - Street 2:#207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1552
Practice Address - Country:US
Practice Address - Phone:714-494-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist