=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922300383
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS HONGSEOK KIM LAC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2010
-----------------------------------------------------
Last Update Date | 11/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2017 W. OLYMPIC BLVD.
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-480-1000
-----------------------------------------------------
Fax | 213-386-0211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8901 SERAPIS AVE SUIT 27
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-739-0090
-----------------------------------------------------
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 | 5727LAC
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------