Provider Demographics
NPI:1700081411
Name:KIM, JUNG-JOO (DC)
Entity Type:Individual
Prefix:DR
First Name:JUNG-JOO
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23361 EL TORO RD
Mailing Address - Street 2:112
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-6922
Mailing Address - Country:US
Mailing Address - Phone:949-586-5205
Mailing Address - Fax:949-215-0250
Practice Address - Street 1:23361 EL TORO RD
Practice Address - Street 2:112
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-6922
Practice Address - Country:US
Practice Address - Phone:949-586-5205
Practice Address - Fax:949-215-0250
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27619111NN1001X
CAAC7654171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No171100000XOther Service ProvidersAcupuncturist