Provider Demographics
NPI:1902163090
Name:KIM, JUNG KYUNG
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:KYUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2049 P C H STE 107
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2661
Mailing Address - Country:US
Mailing Address - Phone:310-539-9000
Mailing Address - Fax:310-323-5249
Practice Address - Street 1:2049 P C H STE 107
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2661
Practice Address - Country:US
Practice Address - Phone:310-539-9000
Practice Address - Fax:310-323-5249
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12607171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist