=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669927711
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOWARD SUNGJI KIM ACUPUNCTURE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2016
-----------------------------------------------------
Last Update Date | 12/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 W. 6TH #207
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90020-1552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-494-3009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 W 6TH ST # 207
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90020-1522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-494-3009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC13154
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------