Provider Demographics
NPI:1316324122
Name:KIM, HONG SUK (DOM, LAC)
Entity type:Individual
Prefix:DR
First Name:HONG SUK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23504 LYONS AVE
Mailing Address - Street 2:SUITE# 101B
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2500
Mailing Address - Country:US
Mailing Address - Phone:213-255-0337
Mailing Address - Fax:
Practice Address - Street 1:23504 LYONS AVE
Practice Address - Street 2:SUITE# 101B
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2500
Practice Address - Country:US
Practice Address - Phone:213-255-0337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16495171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist