MEDICARE: JIWONG KIM L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC15744	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC15744	OTHER	CA	CALIFORNIA ACUPUNCTURE BOARD

General Provider Information

NPI Number	:	1487056651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIWONG KIM L.AC

Provider Business Mailing Address
First Line	:	14785 JEFFREY RD STE 109
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-0410
Country	:	US
Telephone Number	:	714-461-9160
Fax Number	:	714-461-9160

Provider Business Practice Location Address
First Line	:	14785 JEFFREY RD STE 109
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92618-0410
Country	:	US
Telephone Number	:	714-461-9160
Fax Number	:	714-461-9160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	04/13/2026

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