Provider Demographics
NPI:1619545522
Name:PAN, NAM JO KIM (LAC)
Entity Type:Individual
Prefix:
First Name:NAM JO KIM
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W BELLEVUE DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2591
Mailing Address - Country:US
Mailing Address - Phone:626-376-2172
Mailing Address - Fax:
Practice Address - Street 1:117 W BELLEVUE DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2591
Practice Address - Country:US
Practice Address - Phone:626-376-2172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18944171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist