Provider Demographics
NPI:1194931329
Name:KIM, HYUNG JIK (LAC)
Entity type:Individual
Prefix:MR
First Name:HYUNG
Middle Name:JIK
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:7002 MOODY ST
Mailing Address - Street 2:SUITE#111-A
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1180
Mailing Address - Country:US
Mailing Address - Phone:562-860-4543
Mailing Address - Fax:
Practice Address - Street 1:7002 MOODY ST
Practice Address - Street 2:SUITE#111-A
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1180
Practice Address - Country:US
Practice Address - Phone:562-860-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5414171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist