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General NPI Number Information
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NPI Number | 1619019429
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Entity Type | Individual
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Provider Name | SUSAN KIM L.AC.
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Gender | Female
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4950 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90010-3805
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Country | US
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Telephone | 323-965-1050
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Fax | 323-965-1052
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Provider Business Mailing Address
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Address Line | 404 S. SHATTO PL 451-B
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City | LOS ANGELES
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State | CA
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Zip | 90020-1722
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Country | US
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Telephone | 213-507-6918
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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 | AC 9748
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License Number State | CA
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