Healthcare Provider Details

I. General information

NPI: 1386857480
Provider Name (Legal Business Name): PATRICIA KIM N.D., M.S.O.M, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 1/2 N VAN NESS AVE
LOS ANGELES CA
90038-3108
US

IV. Provider business mailing address

1969 N ALEXANDRIA AVE
LOS ANGELES CA
90027-1742
US

V. Phone/Fax

Practice location:
  • Phone: 323-988-4051
  • Fax: 213-426-0813
Mailing address:
  • Phone: 562-760-2162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND 55
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 10051
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: