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General NPI Number Information
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NPI Number | 1558575407
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Entity Type | Individual
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Provider Name | MR. CHAN HO KIM
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Gender | Male
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 555 W REDONDO BEACH BLVD
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City | GARDENA
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State | CA
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Zip | 90248-1612
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Country | US
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Telephone | 310-756-0001
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Fax | 310-756-0004
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Provider Business Mailing Address
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Address Line | 24639 WILLOW TER
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City | HARBOR CITY
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State | CA
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Zip | 90710-4570
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Country | US
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Telephone | 213-268-5337
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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 | AC7574
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License Number State | CA
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