Provider Demographics
NPI:1700145455
Name:CASTRO-KIM, VERONICA (MSOM)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:CASTRO-KIM
Suffix:
Gender:F
Credentials:MSOM
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:VERONICA
Other - Last Name:CASTRO-KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2 NATURE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3828
Mailing Address - Country:US
Mailing Address - Phone:949-491-5571
Mailing Address - Fax:
Practice Address - Street 1:5100 E LA PALMA AVE STE 104
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2081
Practice Address - Country:US
Practice Address - Phone:714-779-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14664171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist