Provider Demographics
NPI:1376837559
Name:KIM, JOHN TAE-KWON (MS, LAC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TAE-KWON
Last Name:KIM
Suffix:
Gender:M
Credentials:MS, LAC
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Mailing Address - Street 1:4600 N JOSEY LN
Mailing Address - Street 2:# 717
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4616
Mailing Address - Country:US
Mailing Address - Phone:615-415-1876
Mailing Address - Fax:
Practice Address - Street 1:501 TROPHY LAKE DR
Practice Address - Street 2:SUITE 322
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5222
Practice Address - Country:US
Practice Address - Phone:214-643-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01261171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist