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General NPI Number Information
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NPI Number | 1902013741
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Entity Type | Individual
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Provider Name | SANG JO KIM L.AC.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 12402 INDUSTRIAL BLVD UNIT B2
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City | VICTORVILLE
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State | CA
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Zip | 92395-5871
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Country | US
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Telephone | 760-428-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 2150 CHEYENNE WAY UNIT 177
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City | FULLERTON
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State | CA
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Zip | 92833-4949
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Country | US
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Telephone | 760-428-2800
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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 | AC8143
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License Number State | CA
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