Healthcare Provider Details

I. General information

NPI: 1871411678
Provider Name (Legal Business Name): SUNGHOON KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 WILSHIRE BLVD STE 500
LOS ANGELES CA
90010-3468
US

IV. Provider business mailing address

4055 WILSHIRE BLVD STE 500
LOS ANGELES CA
90010-3468
US

V. Phone/Fax

Practice location:
  • Phone: 213-738-0712
  • Fax:
Mailing address:
  • Phone: 213-738-0712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: