Provider Demographics
NPI:1659656163
Name:KIM, JONG JOUNG (LAC, PHD)
Entity Type:Individual
Prefix:DR
First Name:JONG
Middle Name:JOUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 E CHAPMAN AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4142
Mailing Address - Country:US
Mailing Address - Phone:714-869-3919
Mailing Address - Fax:714-871-8882
Practice Address - Street 1:1966 E CHAPMAN AVE
Practice Address - Street 2:SUITE J
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4142
Practice Address - Country:US
Practice Address - Phone:714-869-3919
Practice Address - Fax:714-871-8882
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14047171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist