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General NPI Number Information
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NPI Number | 1225459472
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Entity Type | Individual
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Provider Name | SUNG SOO KIM L.AC.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2013
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 1101 DOVE ST STE 270
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2819
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Country | US
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Telephone | 714-200-6050
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Fax |
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Provider Business Mailing Address
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Address Line | 24101 HOLLYOAK APT C
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City | ALISO VIEJO
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State | CA
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Zip | 92656-7904
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Country | US
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Telephone | 949-615-9117
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Fax |
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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 | ACU 490
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC15575
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License Number State | CA
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