Provider Demographics
NPI:1962091975
Name:KIM, HYUN JUNG (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:HYUN JUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 POMELO WAY
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-2647
Mailing Address - Country:US
Mailing Address - Phone:213-344-7134
Mailing Address - Fax:
Practice Address - Street 1:1351 E CHAPMAN AVE STE G
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3955
Practice Address - Country:US
Practice Address - Phone:213-344-7134
Practice Address - Fax:213-341-2445
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18941171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist