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General NPI Number Information
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NPI Number | 1336506104
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Entity Type | Individual
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Provider Name | JIN KOOK KIM LAC
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Gender | Male
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 18915 NORDHOFF ST STE 6
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City | NORTHRIDGE
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State | CA
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Zip | 91324-3791
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Country | US
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Telephone | 747-998-5330
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Fax | 747-998-5318
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Provider Business Mailing Address
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Address Line | 12047 RICASOLI WAY
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City | PORTER RANCH
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State | CA
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Zip | 91326-4626
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Country | US
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Telephone | 818-403-4265
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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 | 16844
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC16844
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License Number State | CA
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