Provider Demographics
NPI:1528129889
Name:KIM, WON (LAC)
Entity type:Individual
Prefix:DR
First Name:WON
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:3240 WILSHIRE BLVD
Mailing Address - Street 2:SUITE # 290
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1502
Mailing Address - Country:US
Mailing Address - Phone:213-382-0052
Mailing Address - Fax:213-382-5122
Practice Address - Street 1:3240 WILSHIRE BLVD
Practice Address - Street 2:SUITE # 290
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1502
Practice Address - Country:US
Practice Address - Phone:213-382-0052
Practice Address - Fax:213-382-5122
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CALAC. 1364171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist