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General NPI Number Information
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NPI Number | 1831721901
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Entity Type | Individual
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Provider Name | SOOHEE KIM LAC
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Gender | Female
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Dates
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Enumeration Date | 02/06/2020
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 4221 WILSHIRE BLVD STE 284
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City | LOS ANGELES
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State | CA
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Zip | 90010-3509
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Country | US
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Telephone | 310-878-2654
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Fax |
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Provider Business Mailing Address
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Address Line | 856 S WALNUT ST
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City | ANAHEIM
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State | CA
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Zip | 92802-1704
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Country | US
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Telephone | 213-505-6461
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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 | AC18781
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License Number State | CA
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