Provider Demographics
NPI:1134311699
Name:KIM, JUNG HEE (OMD)
Entity Type:Individual
Prefix:MS
First Name:JUNG
Middle Name:HEE
Last Name:KIM
Suffix:
Gender:F
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 W TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4822
Mailing Address - Country:US
Mailing Address - Phone:213-383-1700
Mailing Address - Fax:213-383-6940
Practice Address - Street 1:2650 W TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4822
Practice Address - Country:US
Practice Address - Phone:213-383-1700
Practice Address - Fax:213-383-6940
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6251171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist