Provider Demographics
NPI:1407215486
Name:KIM, YOUNG ZOO (LAC)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:ZOO
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 1:7227 BAIRNSDALE ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240
Mailing Address - Country:US
Mailing Address - Phone:562-278-6960
Mailing Address - Fax:
Practice Address - Street 1:1001 S. VERMONT AVE
Practice Address - Street 2:#207
Practice Address - City:L.A.
Practice Address - State:CA
Practice Address - Zip Code:90006
Practice Address - Country:US
Practice Address - Phone:213-388-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16599171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist