MEDICARE: JAMIE JAKYUN KIM LAC

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	AC18310	CA

General Provider Information

NPI Number	:	1689147787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE JAKYUN KIM LAC

Provider Business Mailing Address
First Line	:	1942 AVENIDA DEL OSSA
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92833-1856
Country	:	US
Telephone Number	:	714-422-8461
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 W CHAPMAN AVE STE 102
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-2648
Country	:	US
Telephone Number	:	714-512-1978
Fax Number	:	714-948-8243

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

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	05/09/2019

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