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General NPI Number Information
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NPI Number | 1326319344
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Entity Type | Individual
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Provider Name | MI JUNG KIM
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Gender | Female
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 9618 GARDEN GROVE BLVD STE 221
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City | GARDEN GROVE
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State | CA
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Zip | 92844-1570
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Country | US
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Telephone | 714-539-6562
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Fax |
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Provider Business Mailing Address
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Address Line | 5551 MONTICELLO AVE
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City | BUENA PARK
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State | CA
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Zip | 90621-1543
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Country | US
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Telephone | 714-917-9453
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Fax |
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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 | AC12821
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License Number State | CA
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