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General NPI Number Information
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NPI Number | 1770908618
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Entity Type | Individual
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Provider Name | JAE NAM KIM
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Gender | Female
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Dates
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Enumeration Date | 03/02/2014
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Last Update Date | 03/02/2014
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Provider Practice Location Address
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Address Line | 1661 NOGALES ST SUITE D
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-2988
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Country | US
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Telephone | 626-964-1508
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Fax | 626-964-5908
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Provider Business Mailing Address
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Address Line | 1661 NOGALES ST SUITE D
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-2988
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Country | US
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Telephone | 626-964-1508
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Fax | 626-964-5908
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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 | AC6961
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License Number State | CA
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