Provider Demographics
NPI:1184968703
Name:KIM, JOHN J (LAC MS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20331 ALLPORT LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5101
Mailing Address - Country:US
Mailing Address - Phone:714-904-6718
Mailing Address - Fax:
Practice Address - Street 1:20331 ALLPORT LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-5101
Practice Address - Country:US
Practice Address - Phone:714-904-6718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12667171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist