Provider Demographics
NPI:1750658076
Name:KIM-JACOBSON, JENNY JAEHYUN (LAC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:JAEHYUN
Last Name:KIM-JACOBSON
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 1:55 EASTERN PKWY APT 2A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5911
Mailing Address - Country:US
Mailing Address - Phone:646-250-8953
Mailing Address - Fax:
Practice Address - Street 1:55 EASTERN PKWY APT 2A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5911
Practice Address - Country:US
Practice Address - Phone:646-250-8953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004692171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist