Provider Demographics
NPI:1982837480
Name:KIM, JENNIFER PEEA (MS, LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PEEA
Last Name:KIM
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:J
Other - Middle Name:PEEA
Other - Last Name:KIM-HASSEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LAC
Mailing Address - Street 1:3030 ASHBY AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2453
Mailing Address - Country:US
Mailing Address - Phone:510-318-2054
Mailing Address - Fax:
Practice Address - Street 1:3030 ASHBY AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2453
Practice Address - Country:US
Practice Address - Phone:510-318-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12324171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist