Healthcare Provider Details

I. General information

NPI: 1891972519
Provider Name (Legal Business Name): HO JUN KIM LIC. ACU.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 S 4TH ST SUITE A
EL CENTRO CA
92243-4742
US

IV. Provider business mailing address

1121 S 4TH ST SUITE A
EL CENTRO CA
92243-4742
US

V. Phone/Fax

Practice location:
  • Phone: 760-370-0516
  • Fax:
Mailing address:
  • Phone: 760-370-0516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: