Active NPI
Changbae Kim, L.AC
- Acupuncturist
- Fullerton, CA
National Provider Identifier
1336924646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC17583
- Practice address
- 100 N State College Blvd Ste E
Fullerton, CA 92831-4236 - Phone
- (562) 822-8912
- NPI assigned
- Aug 28, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC17583 | CA | Primary |
Addresses
Primary practice location
100 N State College Blvd Ste E
Fullerton, CA 92831-4236
Mailing address
13229 Carolyn St
Cerritos, CA 90703-8605
Phone (562) 822-8912
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC17583 | CA | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| NPI 1427833730 | Acupuncturist | Current | Accepting new patients |
Locations
100 N State College Blvd
Ste E
Fullerton, CA 92831
Phone (562) 822-8912
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693180800000",
"number": "1336924646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13229 CAROLYN ST",
"city": "CERRITOS",
"state": "CA",
"postal_code": "907038605",
"telephone_number": "562-822-8912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 N STATE COLLEGE BLVD STE E",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928314236",
"telephone_number": "562-822-8912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "CHANGBAE",
"name_prefix": "Mr.",
"credential": "L.AC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-28",
"last_updated": "2023-08-28",
"certification_date": "2023-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC17583",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fullerton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.