Provider Demographics
NPI:1497904601
Name:KIM, JUNGHEE JASON (LAC)
Entity Type:Individual
Prefix:
First Name:JUNGHEE
Middle Name:JASON
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14104 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4604
Mailing Address - Country:US
Mailing Address - Phone:714-636-3886
Mailing Address - Fax:714-636-3459
Practice Address - Street 1:14104 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4604
Practice Address - Country:US
Practice Address - Phone:714-636-3886
Practice Address - Fax:714-636-3459
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12178171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist