Provider Demographics
NPI:1285876052
Name:KIM, JANG HYUCK (LAC)
Entity type:Individual
Prefix:MR
First Name:JANG
Middle Name:HYUCK
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 1:13655 FOSTER AVE UNIT 10
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-8029
Mailing Address - Country:US
Mailing Address - Phone:818-288-5758
Mailing Address - Fax:
Practice Address - Street 1:13655 FOSTER AVE UNIT 10
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-8029
Practice Address - Country:US
Practice Address - Phone:818-288-5758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2013-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12937171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist