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General NPI Number Information
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NPI Number | 1689147787
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Entity Type | Individual
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Provider Name | JAMIE JAKYUN KIM LAC
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Gender | Male
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 2050 W CHAPMAN AVE STE 102
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City | ORANGE
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State | CA
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Zip | 92868-2648
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Country | US
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Telephone | 714-512-1978
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Fax | 714-948-8243
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Provider Business Mailing Address
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Address Line | 1942 AVENIDA DEL OSSA
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City | FULLERTON
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State | CA
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Zip | 92833-1856
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Country | US
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Telephone | 714-422-8461
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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 | AC18310
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License Number State | CA
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