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General NPI Number Information
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NPI Number | 1003933839
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Entity Type | Individual
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Provider Name | KIMI XIAO GUDMUNDSEN L.AC.
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Gender | Female
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Dates
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Enumeration Date | 03/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 20265 VALLEY BLVD STE E
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City | WALNUT
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State | CA
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Zip | 91789-2655
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Country | US
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Telephone | 626-993-5108
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Fax | 909-869-8401
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Provider Business Mailing Address
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Address Line | 8037 E DESERT PINE DR
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City | ANAHEIM
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State | CA
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Zip | 92808-2414
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Country | US
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Telephone | 626-993-5108
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Fax | 714-280-8488
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC8229
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License Number State | CA
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