Provider Demographics
NPI:1144653064
Name:KIM, SANGBUMN
Entity type:Individual
Prefix:
First Name:SANGBUMN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W CHESTER PIKE
Mailing Address - Street 2:#103A
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4500
Mailing Address - Country:US
Mailing Address - Phone:610-789-3678
Mailing Address - Fax:
Practice Address - Street 1:525 W CHESTER PIKE
Practice Address - Street 2:#103A
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4500
Practice Address - Country:US
Practice Address - Phone:610-789-3678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001084171100000X
NY005122171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist