Provider Demographics
NPI:1932659083
Name:KIM, JINHEE
Entity Type:Individual
Prefix:
First Name:JINHEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3842 GREEN AVE
Mailing Address - Street 2:#1
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3331
Mailing Address - Country:US
Mailing Address - Phone:213-820-4532
Mailing Address - Fax:
Practice Address - Street 1:3842 GREEN AVE
Practice Address - Street 2:#1
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3331
Practice Address - Country:US
Practice Address - Phone:213-820-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 17309171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 17309OtherACUPUNCTURE BOARD