Provider Demographics
NPI:1235679630
Name:MK NATUROPATHIC AND ACUPUNCTURE INC
Entity Type:Organization
Organization Name:MK NATUROPATHIC AND ACUPUNCTURE INC
Other - Org Name:MK INTEGRATIVE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIN KYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:619-309-6069
Mailing Address - Street 1:10810 SABRE HILL DR UNIT 180
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4180
Mailing Address - Country:US
Mailing Address - Phone:619-309-6069
Mailing Address - Fax:619-550-0569
Practice Address - Street 1:6540 LUSK BLVD STE C139
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2696
Practice Address - Country:US
Practice Address - Phone:619-309-6069
Practice Address - Fax:619-550-0569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14637171100000X
CAND854175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty