Healthcare Provider Details

I. General information

NPI: 1497955892
Provider Name (Legal Business Name): HAI OK KIM L,AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9240 GARDEN GROVE BLVD STE 2
GARDEN GROVE CA
92844-1400
US

IV. Provider business mailing address

9240 GARDEN GROVE BLVD STE 2
GARDEN GROVE CA
92844-1400
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-1412
  • Fax: 714-530-3100
Mailing address:
  • Phone: 714-636-1412
  • Fax: 714-530-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC4710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: