Healthcare Provider Details

I. General information

NPI: 1619758133
Provider Name (Legal Business Name): MJ INTEGRATIVE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1384 W FOOTHILL BLVD APT 10
UPLAND CA
91786-3648
US

IV. Provider business mailing address

1384 W FOOTHILL BLVD APT 10
UPLAND CA
91786-3648
US

V. Phone/Fax

Practice location:
  • Phone: 909-247-9532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. MIJI KIM
Title or Position: CEO
Credential: ACUPUNCTURIST
Phone: 909-247-9532