Chung Soo Kim, AC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC18430 Issued in CA

Practice address

21217 Washington Ave SPC 13
Walnut, CA 91789-3300

Phone

(909) 630-9005

Fax

(818) 855-8061

NPI assigned

Mar 7, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Acusana Acupuncture Inc

  • Acupuncturist
  • Garden Grove, CA
  • NPI 1194567040
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551916800000",
    "number": "1619435765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21217 WASHINGTON AVE SPC 13",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917893300",
            "telephone_number": "909-630-9005",
            "fax_number": "818-855-8061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21217 WASHINGTON AVE SPC 13",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917893300",
            "telephone_number": "909-630-9005",
            "fax_number": "818-855-8061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "CHUNG",
        "middle_name": "SOO",
        "name_prefix": "Dr.",
        "credential": "AC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-07",
        "last_updated": "2019-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC18430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry Hsing-Lu Kao, BCBA, LMFT
• Karen Lee DMD Inc
• Kenvis Ngow DDS Inc
• Key Way Medical Inc.
• Christine Heeyoung Kim, PHARM.D
• Debi Kim, PH.D
• Erica Kim, D.D.S.
• Esther Kim
• Eun Jung Kim
• Sungyun Kim

• Acupuncturist in Walnut, CA
• Providers in Walnut, CA by specialty
• Acupuncturist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.