Provider Demographics
NPI:1689217770
Name:KIM, YOO KYONG (LAC)
Entity type:Individual
Prefix:
First Name:YOO KYONG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1584 AVENIDA SELVA
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-1553
Mailing Address - Country:US
Mailing Address - Phone:949-309-7717
Mailing Address - Fax:
Practice Address - Street 1:301 W BASTANCHURY RD STE 5
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3422
Practice Address - Country:US
Practice Address - Phone:949-309-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18706171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist