Active NPI
Grace Jung Kim
- Acupuncturist
- Phelan, CA
National Provider Identifier
1164567772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC9027
- Practice address
- 3777 Phelan Rd
Phelan, CA 92371-9074 - Phone
- (760) 868-5618
- Fax
- (760) 868-6688
- NPI assigned
- Feb 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC9027 | CA | Primary |
Addresses
Primary practice location
3777 Phelan Rd
Phelan, CA 92371-9074
Mailing address
4834 Smoke Tree Rd
Phelan, CA 92371-6883
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC9027 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316476800000",
"number": "1164567772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4834 SMOKE TREE RD",
"city": "PHELAN",
"state": "CA",
"postal_code": "923716883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3777 PHELAN RD",
"city": "PHELAN",
"state": "CA",
"postal_code": "923719074",
"telephone_number": "760-868-5618",
"fax_number": "760-868-6688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "GRACE",
"middle_name": "JUNG",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-21",
"last_updated": "2011-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC9027",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phelan, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.