Provider Demographics
NPI:1306609995
Name:KIM, YUN JUNG (LAC)
Entity type:Individual
Prefix:
First Name:YUN
Middle Name:JUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORPORATE POINTE STE 150A
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7645
Mailing Address - Country:US
Mailing Address - Phone:310-453-8300
Mailing Address - Fax:310-453-8383
Practice Address - Street 1:200 CORPORATE POINTE STE 150A
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7645
Practice Address - Country:US
Practice Address - Phone:310-453-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19676171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist