Healthcare Provider Details

I. General information

NPI: 1447501853
Provider Name (Legal Business Name): KIYOUNG HUH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 S CENTRAL AVE APT 211
LOS ANGELES CA
90012-4257
US

IV. Provider business mailing address

223 S CENTRAL AVE APT 211
LOS ANGELES CA
90012-4257
US

V. Phone/Fax

Practice location:
  • Phone: 818-334-9943
  • Fax:
Mailing address:
  • Phone: 818-334-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: