Provider Demographics
NPI:1962908020
Name:KIM, CHULL SOO (PHD, TCM , OMD)
Entity type:Individual
Prefix:DR
First Name:CHULL SOO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHD, TCM , OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 E MAIN ST APT M207
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-7073
Mailing Address - Country:US
Mailing Address - Phone:215-678-8028
Mailing Address - Fax:
Practice Address - Street 1:7 HEDGE PL
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-4716
Practice Address - Country:US
Practice Address - Phone:215-678-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000148171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist