Healthcare Provider Details

I. General information

NPI: 1568693042
Provider Name (Legal Business Name): SAI-KYOUNG IRENE KIM O.M.D., L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2009
Last Update Date: 08/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD SUITE 825
LOS ANGELES CA
90025-1708
US

IV. Provider business mailing address

11645 WILSHIRE BLVD SUITE 825
LOS ANGELES CA
90025-1708
US

V. Phone/Fax

Practice location:
  • Phone: 310-207-3320
  • Fax: 310-820-5868
Mailing address:
  • Phone: 310-207-3320
  • Fax: 310-820-5868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 9683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: