Provider Demographics
NPI:1447445598
Name:KIM, MINSUK (LAC)
Entity type:Individual
Prefix:
First Name:MINSUK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:11121 VALLEY SPRING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3730
Mailing Address - Country:US
Mailing Address - Phone:704-228-1311
Mailing Address - Fax:980-422-0489
Practice Address - Street 1:7810 BALLANTYNE COMMONS PKWY STE 225
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3416
Practice Address - Country:US
Practice Address - Phone:310-975-9129
Practice Address - Fax:980-422-0489
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC9465171100000X
NC2039171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist