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General NPI Number Information
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NPI Number | 1245539758
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Entity Type | Individual
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Provider Name | JI SUN KIM L.AC
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Gender | Female
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Dates
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Enumeration Date | 03/23/2011
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Last Update Date | 02/11/2017
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Provider Practice Location Address
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Address Line | 1825 HAMNER AVE STE R
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City | NORCO
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State | CA
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Zip | 92860-2974
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Country | US
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Telephone | 951-582-9700
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Fax | 951-582-9733
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Provider Business Mailing Address
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Address Line | 1825 HAMNER AVE STE R
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City | NORCO
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State | CA
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Zip | 92860-2974
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Country | US
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Telephone | 951-582-9700
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Fax | 951-582-9733
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 12159
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 66733
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License Number State | CA
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