Provider Demographics
NPI:1104261387
Name:KIM, SANG KYEONG (LAC)
Entity type:Individual
Prefix:MR
First Name:SANG
Middle Name:KYEONG
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 S KING ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2506
Mailing Address - Country:US
Mailing Address - Phone:808-354-3775
Mailing Address - Fax:
Practice Address - Street 1:1451 S KING ST
Practice Address - Street 2:SUITE 402
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2506
Practice Address - Country:US
Practice Address - Phone:808-354-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1044171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist