Healthcare Provider Details

I. General information

NPI: 1386013928
Provider Name (Legal Business Name): S-WONNY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CRESCENT DR SUITE 140
BEVERLY HILLS CA
90210-4860
US

IV. Provider business mailing address

415 N CRESCENT DR SUITE 140
BEVERLY HILLS CA
90210-4860
US

V. Phone/Fax

Practice location:
  • Phone: 310-601-6260
  • Fax:
Mailing address:
  • Phone: 310-601-6260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number11692
License Number StateCA

VIII. Authorized Official

Name: MYOUNG S KIM
Title or Position: MANAGER
Credential:
Phone: 310-601-6260