Basic Information
| Provider Information | |||||||||
| NPI: | 1760774970 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLINE | ||||||||
| FirstName: | SUZIE | ||||||||
| MiddleName: | SEOYANG | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | F.N.P. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LEE | ||||||||
| OtherFirstName: | SEOYANG | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 625 SOUTH FAIR OAKS AVE | ||||||||
| Address2: | #100 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263972537 | ||||||||
| FaxNumber: | 6263972147 | ||||||||
| Practice Location | |||||||||
| Address1: | 2428 SANTA MONICA BLVD | ||||||||
| Address2: | #208 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109989118 | ||||||||
| FaxNumber: | 3108299318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2011 | ||||||||
| LastUpdateDate: | 02/20/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AC9115 | CA | N | Other Service Providers | Acupuncturist | 261QM2500X | 19208 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.