Individual provider Active NPI

Jae Seung Kim, L.AC., PH.D.

  • Acupuncturist
  • Los Angeles, CA
National Provider Identifier
1043359482
Registry record updated Apr 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
4989 Issued in CA
Practice address
3400 W Olympic BL
Ste207
Los Angeles, CA 90019-2122
Phone
(213) 365-2277
Fax
(213) 385-3710
NPI assigned
Feb 5, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X 4989 CA Primary

Addresses

Primary practice location

3400 W Olympic BL
Ste207
Los Angeles, CA 90019-2122

Mailing address

3400 W Olympic BL
Ste207
Los Angeles, CA 90019-2122
Phone (213) 365-2277

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Acumedi Health Center Acupuncture Inc. Acupuncturist CurrentSince Apr 5, 2020 Accepting new patients
Acumedi Acupuncturist Past Accepting new patients

Locations

4055 Wilshire Blvd
Ste 250
Los Angeles, CA 90010

3400 W Olympic Blvd
Ste 207
Los Angeles, CA 90019
Phone (213) 365-2277

430 S Western Ave
Ste 102A
Los Angeles, CA 90020
Phone (213) 365-2277

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585785600000",
    "number": "1043359482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 W OLYMPIC BL",
            "address_2": "STE207",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900192122",
            "telephone_number": "213-365-2277",
            "fax_number": "213-385-3710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 W OLYMPIC BL",
            "address_2": "STE207",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900192122",
            "telephone_number": "213-365-2277",
            "fax_number": "213-385-3710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JAE",
        "middle_name": "SEUNG",
        "name_prefix": "Dr.",
        "credential": "L.AC., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "4989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.