Provider Demographics
NPI:1649619412
Name:SON, JAEJIN (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:JAEJIN
Middle Name:
Last Name:SON
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 RUFFNER ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111
Mailing Address - Country:US
Mailing Address - Phone:760-650-6660
Mailing Address - Fax:
Practice Address - Street 1:4655 RUFFNER ST STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO, CA 92111
Practice Address - State:CA
Practice Address - Zip Code:92111
Practice Address - Country:US
Practice Address - Phone:760-650-6660
Practice Address - Fax:760-650-6660
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46-2950620171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA46-2950620OtherLICENSED ACUPUNCTURIST