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General NPI Number Information
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NPI Number | 1841460342
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Entity Type | Individual
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Provider Name | JAYNE KIM L.AC.
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Gender | Female
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 4017 WILSHIRE BLVD # A
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City | LOS ANGELES
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State | CA
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Zip | 90010-3401
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Country | US
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Telephone | 132-284-1133
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Fax |
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Provider Business Mailing Address
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Address Line | 1319 N LA BREA AVE
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City | HOLLYWOOD
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State | CA
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Zip | 90028-7503
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Country | US
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Telephone | 323-876-7708
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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 | AC9977
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License Number State | CA
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