Healthcare Provider Details

I. General information

NPI: 1902734783
Provider Name (Legal Business Name): PUNG KWAN KIM L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 N BROOKHURST ST STE 100
ANAHEIM CA
92801-5620
US

IV. Provider business mailing address

431 N BROOKHURST ST STE 100
ANAHEIM CA
92801-5620
US

V. Phone/Fax

Practice location:
  • Phone: 714-757-6622
  • Fax: 657-202-3681
Mailing address:
  • Phone: 714-757-6622
  • Fax: 657-202-3681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: