Provider Demographics
NPI:1164692471
Name:KIMBERLY HOOVER L.AC.
Entity Type:Organization
Organization Name:KIMBERLY HOOVER L.AC.
Other - Org Name:ACU-CARE HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:619-282-8068
Mailing Address - Street 1:2852 ADAMS AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1407
Mailing Address - Country:US
Mailing Address - Phone:619-282-8068
Mailing Address - Fax:619-282-5966
Practice Address - Street 1:2852 ADAMS AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116
Practice Address - Country:US
Practice Address - Phone:619-282-8068
Practice Address - Fax:619-282-5966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACU CARE HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4093171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6AC000250Medicaid