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General NPI Number Information
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NPI Number | 1922669456
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Entity Type | Organization
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Legal Business Name | KSJ ACUPUNCTURE CLINIC, INC.
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Dates
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Enumeration Date | 06/25/2019
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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 STE B2
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City | VICTORVILLE
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State | CA
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Zip | 92395-5889
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Country | US
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Telephone | 760-428-2800
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Fax | 657-255-4049
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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 | 92833-4939
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Country | US
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Telephone | 760-428-2800
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Fax | 657-255-4049
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. SANG JO KIM
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Credential | DAOM, L.AC.
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Telephone | 760-428-2800
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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 |
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License Number State |
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