Provider Demographics
NPI:1649506676
Name:KIM, KYOPNG T (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:KYOPNG
Middle Name:T
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14838 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1328
Mailing Address - Country:US
Mailing Address - Phone:818-385-0916
Mailing Address - Fax:818-907-9262
Practice Address - Street 1:14838 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1328
Practice Address - Country:US
Practice Address - Phone:818-385-0916
Practice Address - Fax:818-907-9262
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13341171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC13341OtherACUPUNCTURE