Provider Demographics
NPI:1992485064
Name:KIM, JANICE HYUNJY (LAC)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:HYUNJY
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 HUNTINGTON DR STE 288
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2253
Mailing Address - Country:US
Mailing Address - Phone:213-864-1925
Mailing Address - Fax:
Practice Address - Street 1:2920 HUNTINGTON DR STE 288
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2253
Practice Address - Country:US
Practice Address - Phone:213-864-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC19787171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist