Healthcare Provider Details

I. General information

NPI: 1891932836
Provider Name (Legal Business Name): SUN HYU KIM L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10141 WESTMINSTER AVE #204
GARDEN GROVE CA
92843-4788
US

IV. Provider business mailing address

10141 WESTMINSTER AVE #204
GARDEN GROVE CA
92843-4788
US

V. Phone/Fax

Practice location:
  • Phone: 714-590-9872
  • Fax: 714-590-2232
Mailing address:
  • Phone: 714-590-9872
  • Fax: 714-590-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: