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General NPI Number Information
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NPI Number | 1326582883
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Entity Type | Organization
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Legal Business Name | STAR SPORTS & ACUPUNCTURE CLINIC INC.
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 2426 W 8TH ST STE 101
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City | LOS ANGELES
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State | CA
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Zip | 90057-3840
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Country | US
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Telephone | 213-536-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 2426 W 8TH ST STE 101
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City | LOS ANGELES
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State | CA
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Zip | 90057-3840
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Country | US
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Telephone | 213-536-0011
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Fax |
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Authorized Official
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Title or Position | C.E.O
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Name | ROBIN DONG SIK KIM
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Credential | L.AC, PHD
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Telephone | 213-536-0011
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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 | AC9663
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License Number State | CA
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