Healthcare Provider Details

I. General information

NPI: 1619195583
Provider Name (Legal Business Name): HYON BIN KANG L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 WILSHIRE BLVD STE 240
BEVERLY HILLS CA
90211-3135
US

IV. Provider business mailing address

8501 WILSHIRE BLVD SUITE 240
BEVERLY HILLS CA
90211-3150
US

V. Phone/Fax

Practice location:
  • Phone: 310-854-0059
  • Fax: 310-854-0069
Mailing address:
  • Phone: 310-854-0059
  • Fax: 310-854-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 10689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: