=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861823874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRSONS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2013
-----------------------------------------------------
Last Update Date | 12/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4330 BARRANCA PKWY STE #232
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92604-4755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-697-8582
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 SANTA CATALINA AISLE
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92606-0860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-697-8582
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MOON JUNG KIM
-----------------------------------------------------
Credential | L.AC. PH.D
-----------------------------------------------------
Telephone | 949-697-8582
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC13550
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------