Provider Demographics
NPI:1356601520
Name:KIM, KYUNG HWAN (LAC)
Entity type:Individual
Prefix:
First Name:KYUNG
Middle Name:HWAN
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3460 WILSHIRE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2223
Mailing Address - Country:US
Mailing Address - Phone:213-413-9500
Mailing Address - Fax:213-413-5400
Practice Address - Street 1:3460 WILSHIRE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010
Practice Address - Country:US
Practice Address - Phone:213-413-9500
Practice Address - Fax:213-413-5400
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC9792171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist