Provider Demographics
NPI:1861609240
Name:KIM, MIN KYUNG
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:KYUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1418 S EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-3135
Mailing Address - Country:US
Mailing Address - Phone:714-578-0580
Mailing Address - Fax:714-578-0585
Practice Address - Street 1:1418 S EUCLID ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-3135
Practice Address - Country:US
Practice Address - Phone:714-578-0580
Practice Address - Fax:714-578-0585
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208891670171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist