Provider Demographics
NPI:1245451772
Name:KIM, JASON JONGWOON (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JONGWOON
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16303 S. WESTERN AVE.
Mailing Address - Street 2:SUITE 9
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4674
Mailing Address - Country:US
Mailing Address - Phone:310-538-9917
Mailing Address - Fax:310-538-9918
Practice Address - Street 1:16303 S. WESTERN AVE.
Practice Address - Street 2:SUITE 9
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4674
Practice Address - Country:US
Practice Address - Phone:310-538-9917
Practice Address - Fax:310-538-9918
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9925171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist