Healthcare Provider Details

I. General information

NPI: 1265241871
Provider Name (Legal Business Name): KIM HOANG JENSEN D.A.C.M., LA.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 GRAND AVENUE SUITE 105
SAN MARCOS CA
92078
US

IV. Provider business mailing address

2035 CHEROKEE LANE
ESCONDIDO CA
92026-1700
US

V. Phone/Fax

Practice location:
  • Phone: 760-891-8083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC20199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: