Provider Demographics
NPI:1881926830
Name:KIM, JUNGHEE (L AC)
Entity type:Individual
Prefix:
First Name:JUNGHEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 BROTHERS BLVD
Mailing Address - Street 2:SUITE # E
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5474
Mailing Address - Country:US
Mailing Address - Phone:979-485-8068
Mailing Address - Fax:979-485-8068
Practice Address - Street 1:1804 BROTHERS BLVD
Practice Address - Street 2:SUITE # E
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5474
Practice Address - Country:US
Practice Address - Phone:979-485-8068
Practice Address - Fax:979-485-8068
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00863171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist