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General NPI Number Information
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NPI Number | 1932525748
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Entity Type | Organization
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Legal Business Name | KC ACUPUNCTURE & HERBS, INC.
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 1914 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90018-1537
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Country | US
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Telephone | 909-320-0695
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Fax |
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Provider Business Mailing Address
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Address Line | 11344 NAPOLI DR
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-8532
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Country | US
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Telephone | 909-320-0695
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / C.E.O.
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Name | CASEY Y. KIM
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Credential | L.AC., PH.D.
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Telephone | 909-320-0695
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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 | AC15345
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License Number State | CA
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