Provider Demographics
NPI:1669519856
Name:KIM, JUNG KI (LAC)
Entity type:Individual
Prefix:MR
First Name:JUNG
Middle Name:KI
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:2503 N. FRESNO ST.
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703
Mailing Address - Country:US
Mailing Address - Phone:559-226-5531
Mailing Address - Fax:559-226-6503
Practice Address - Street 1:2503 N. FRESNO ST.
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703
Practice Address - Country:US
Practice Address - Phone:559-226-5531
Practice Address - Fax:559-226-6503
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2425171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist