=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649506676
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYOPNG T KIM ACUPUNCTURIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2009
-----------------------------------------------------
Last Update Date | 10/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14838 MAGNOLIA BLVD
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-1328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-385-0916
-----------------------------------------------------
Fax | 818-907-9262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14838 MAGNOLIA BLVD
-----------------------------------------------------
City | SHERMAN OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91403-1328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-385-0916
-----------------------------------------------------
Fax | 818-907-9262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 13341
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------