Provider Demographics
NPI:1730431024
Name:KIM, JONGHEE (LAC)
Entity type:Individual
Prefix:MR
First Name:JONGHEE
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:12600 BROOKHURST ST
Mailing Address - Street 2:# 201
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4833
Mailing Address - Country:US
Mailing Address - Phone:714-420-9731
Mailing Address - Fax:714-636-6001
Practice Address - Street 1:12600 BROOKHURST ST
Practice Address - Street 2:# 201
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4833
Practice Address - Country:US
Practice Address - Phone:714-420-9731
Practice Address - Fax:714-636-6001
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2015-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC12217171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist