Provider Demographics
NPI:1356985709
Name:KIM, JIYOUNG (ND, LAC)
Entity type:Individual
Prefix:
First Name:JIYOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 164TH ST SW APT 1613
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-3251
Mailing Address - Country:US
Mailing Address - Phone:206-491-3197
Mailing Address - Fax:
Practice Address - Street 1:3116 164TH ST SW APT 1613
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-3251
Practice Address - Country:US
Practice Address - Phone:206-491-3197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175F00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath