Provider Demographics
NPI:1790348886
Name:KIM, JIN HO (EAMP, LAC)
Entity Type:Individual
Prefix:DR
First Name:JIN
Middle Name:HO
Last Name:KIM
Suffix:
Gender:M
Credentials:EAMP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18623 HIGHWAY 99 STE 260
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4555
Mailing Address - Country:US
Mailing Address - Phone:425-273-0023
Mailing Address - Fax:425-491-7791
Practice Address - Street 1:18623 HIGHWAY 99 STE 260
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4555
Practice Address - Country:US
Practice Address - Phone:425-273-0023
Practice Address - Fax:425-491-7791
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60903384171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist