Provider Demographics
NPI:1184653693
Name:KIM, JUNG K (LAC)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1510 W VERDUGO AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2473
Mailing Address - Country:US
Mailing Address - Phone:818-558-7146
Mailing Address - Fax:818-558-7217
Practice Address - Street 1:1510 W VERDUGO AVE STE D
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2473
Practice Address - Country:US
Practice Address - Phone:818-558-7146
Practice Address - Fax:818-558-7217
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8065171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist