Provider Demographics
NPI:1740599869
Name:KIM, JI WOO
Entity Type:Individual
Prefix:
First Name:JI
Middle Name:WOO
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 1:424 S 308TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4025
Mailing Address - Country:US
Mailing Address - Phone:253-347-3745
Mailing Address - Fax:253-941-0908
Practice Address - Street 1:424 S 308TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4025
Practice Address - Country:US
Practice Address - Phone:253-347-3745
Practice Address - Fax:253-941-0908
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002721171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist