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NPI Code Detail

MEDICARE: SEONGJO KIM

MEDICARE: SEONGJO KIM
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
1171100000XAcupuncturist18840CA

General Provider Information

NPI Number : 1679194567
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEONGJO KIM
Provider Business Mailing Address
First Line : 12362 BEACH BLVD STE 10
Second Line :
City : STANTON
State : CA
Zip : 90680-3944
Country : US
Telephone Number : 714-248-9500
Fax Number : 714-622-4943
Provider Business Practice Location Address
First Line : 12362 BEACH BLVD STE 10
Second Line :
City : STANTON
State : CA
Zip : 90680-3944
Country : US
Telephone Number : 714-248-9500
Fax Number : 714-622-4943
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2020
Last Update Date : 04/10/2023

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Directions to “ SEONGJO KIM ” Practice Location

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