Provider Demographics
NPI:1922135698
Name:KIM, HARRISON JONGKU (LAC)
Entity Type:Individual
Prefix:
First Name:HARRISON
Middle Name:JONGKU
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:JONG KU
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1201 S. BEACH BLVD.,
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-9900
Mailing Address - Country:US
Mailing Address - Phone:502-902-1010
Mailing Address - Fax:502-902-1010
Practice Address - Street 1:1201 S. BEACH BLVD.,
Practice Address - Street 2:SUITE 102
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-9900
Practice Address - Country:US
Practice Address - Phone:502-902-1010
Practice Address - Fax:502-902-1010
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist