Provider Demographics
NPI:1386709053
Name:KIM, SUNG J (PHD, OMD, LAC)
Entity type:Individual
Prefix:MS
First Name:SUNG
Middle Name:J
Last Name:KIM
Suffix:
Gender:F
Credentials:PHD, OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9323C LA RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2411
Mailing Address - Country:US
Mailing Address - Phone:916-368-5230
Mailing Address - Fax:
Practice Address - Street 1:9323C LA RIVIERA DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2411
Practice Address - Country:US
Practice Address - Phone:916-368-5230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2607171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist