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General NPI Number Information
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NPI Number | 1689217770
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Entity Type | Individual
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Provider Name | YOO KYONG KIM L.AC.
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Gender | Female
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Dates
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Enumeration Date | 10/22/2019
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Last Update Date | 07/03/2023
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Provider Practice Location Address
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Address Line | 301 W BASTANCHURY RD STE 5
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City | FULLERTON
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State | CA
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Zip | 92835-3422
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Country | US
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Telephone | 949-309-7717
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Fax |
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Provider Business Mailing Address
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Address Line | 1584 AVENIDA SELVA
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City | FULLERTON
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State | CA
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Zip | 92833-1553
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Country | US
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Telephone | 949-309-7717
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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 | AC18706
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License Number State | CA
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