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General NPI Number Information
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NPI Number | 1922289503
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Entity Type | Organization
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Legal Business Name | ST. LUKE UNIVERSITY
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Dates
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Enumeration Date | 11/23/2007
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Last Update Date | 11/23/2007
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Provider Practice Location Address
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Address Line | 1460 E HOLT AVE SUITE 72
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City | POMONA
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State | CA
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Zip | 91767-5856
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Country | US
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Telephone | 909-623-0302
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Fax | 909-623-0480
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Provider Business Mailing Address
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Address Line | 1460 E HOLT AVE SUITE 72
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City | POMONA
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State | CA
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Zip | 91767-5856
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Country | US
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Telephone | 909-623-0302
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Fax | 909-623-0480
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIM YOUNG KIM
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Credential |
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Telephone | 909-623-0302
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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 5732
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License Number State | CA
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