Provider Demographics
NPI:1316347024
Name:KIM, CHRIS SUK JOO
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:SUK JOO
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:S
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AC
Mailing Address - Street 1:10349 BALBOA BLVD #200
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344
Mailing Address - Country:US
Mailing Address - Phone:818-363-3100
Mailing Address - Fax:818-363-5353
Practice Address - Street 1:13132 MESA VERDE WAY
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-3450
Practice Address - Country:US
Practice Address - Phone:213-245-9727
Practice Address - Fax:818-363-5353
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5420171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist