Provider Demographics
NPI:1902243199
Name:KIM, GRACE GIL (AC)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:GIL
Last Name:KIM
Suffix:
Gender:F
Credentials:AC
Other - Prefix:MRS
Other - First Name:GIL
Other - Middle Name:SOON
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AC
Mailing Address - Street 1:2370 CRENSHAW BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-3352
Mailing Address - Country:US
Mailing Address - Phone:310-367-3883
Mailing Address - Fax:
Practice Address - Street 1:2370 CRENSHAW BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-3352
Practice Address - Country:US
Practice Address - Phone:310-367-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10047171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist