Provider Demographics
NPI:1891972519
Name:KIM, HO JUN (LIC ACU)
Entity Type:Individual
Prefix:
First Name:HO JUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LIC ACU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 S 4TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4742
Mailing Address - Country:US
Mailing Address - Phone:760-370-0516
Mailing Address - Fax:
Practice Address - Street 1:1121 S 4TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4742
Practice Address - Country:US
Practice Address - Phone:760-370-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11071171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 11071OtherACUPUNCTURE LICENSE