Provider Demographics
NPI:1194917435
Name:KIM, SAM YONG (PHD)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:YONG
Last Name:KIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4269 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3448
Mailing Address - Country:US
Mailing Address - Phone:213-388-7557
Mailing Address - Fax:213-388-7557
Practice Address - Street 1:4269 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3448
Practice Address - Country:US
Practice Address - Phone:213-388-7557
Practice Address - Fax:213-388-7557
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC0042850171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist