Provider Demographics
NPI:1407393580
Name:KIM, JUN WOO
Entity Type:Individual
Prefix:
First Name:JUN WOO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 W REDONDO BEACH BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3464
Mailing Address - Country:US
Mailing Address - Phone:310-965-0500
Mailing Address - Fax:310-965-0055
Practice Address - Street 1:1251 W REDONDO BEACH BLVD FL 3
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3464
Practice Address - Country:US
Practice Address - Phone:310-965-0500
Practice Address - Fax:310-965-0055
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16949171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist