Healthcare Provider Details

I. General information

NPI: 1750206041
Provider Name (Legal Business Name): PYUNG AE KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S BEACH BLVD STE 108
ANAHEIM CA
92804-1875
US

IV. Provider business mailing address

408 S BEACH BLVD STE 108
ANAHEIM CA
92804-1875
US

V. Phone/Fax

Practice location:
  • Phone: 714-886-2085
  • Fax:
Mailing address:
  • Phone: 714-886-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: