Provider Demographics
NPI:1063623494
Name:KIM, JONG HO (AC)
Entity type:Individual
Prefix:DR
First Name:JONG
Middle Name:HO
Last Name:KIM
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2140 W OLYMPIC BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2279
Mailing Address - Country:US
Mailing Address - Phone:213-383-5313
Mailing Address - Fax:213-383-5356
Practice Address - Street 1:2140 W OLYMPIC BLVD STE 308
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2279
Practice Address - Country:US
Practice Address - Phone:213-383-5313
Practice Address - Fax:213-383-5356
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5785171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist