Provider Demographics
NPI:1154847531
Name:KIM, JO I (LAC, PHD)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:I
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 N FRESNO ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5268
Mailing Address - Country:US
Mailing Address - Phone:559-549-3929
Mailing Address - Fax:855-702-2255
Practice Address - Street 1:6225 N FRESNO ST STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5268
Practice Address - Country:US
Practice Address - Phone:559-549-3929
Practice Address - Fax:855-702-2255
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17709171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist