=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902508898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINEQI ACUWELLNESS CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2023
-----------------------------------------------------
Last Update Date | 03/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6225 N FRESNO ST STE 103
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93710-5268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-549-3929
-----------------------------------------------------
Fax | 855-702-2255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6225 N FRESNO ST STE 103
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93710-5268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-549-3929
-----------------------------------------------------
Fax | 855-702-2255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWENER
-----------------------------------------------------
Name | DR. JO IN KIM
-----------------------------------------------------
Credential | PH.D., L.AC.
-----------------------------------------------------
Telephone | 213-910-7910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------