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General NPI Number Information
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NPI Number | 1497904601
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Entity Type | Individual
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Provider Name | JUNGHEE JASON KIM L.AC
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Gender | Male
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 14104 BROOKHURST ST
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City | GARDEN GROVE
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State | CA
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Zip | 92843-4604
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Country | US
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Telephone | 714-636-3886
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Fax | 714-636-3459
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Provider Business Mailing Address
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Address Line | 14104 BROOKHURST ST
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City | GARDEN GROVE
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State | CA
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Zip | 92843-4604
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Country | US
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Telephone | 714-636-3886
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Fax | 714-636-3459
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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 | 12178
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License Number State | CA
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