Healthcare Provider Details

I. General information

NPI: 1235679630
Provider Name (Legal Business Name): MK NATUROPATHIC AND ACUPUNCTURE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2017
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6540 LUSK BLVD STE C139
SAN DIEGO CA
92121-2696
US

IV. Provider business mailing address

10810 SABRE HILL DR UNIT 180
SAN DIEGO CA
92128-4180
US

V. Phone/Fax

Practice location:
  • Phone: 619-309-6069
  • Fax: 619-550-0569
Mailing address:
  • Phone: 619-309-6069
  • Fax: 619-550-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14637
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND854
License Number StateCA

VIII. Authorized Official

Name: MIN KYUN KIM
Title or Position: CEO
Credential: N.D., L.AC.
Phone: 619-309-6069