Provider Demographics
NPI:1053466920
Name:KIM, NAMSIK (LIC, ACU)
Entity type:Individual
Prefix:
First Name:NAMSIK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LIC, ACU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1522
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-1522
Mailing Address - Country:US
Mailing Address - Phone:360-458-2225
Mailing Address - Fax:360-458-3663
Practice Address - Street 1:715 E YELM AVE STE 5
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-8714
Practice Address - Country:US
Practice Address - Phone:360-458-2225
Practice Address - Fax:360-458-3663
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002749171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist