Active NPI
Jiyeon Kim, L.AC
- Acupuncturist
- San Bernardino, CA
National Provider Identifier
1215155759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC 8676
- Practice address
- 2160 S Waterman Ave Ste D
San Bernardino, CA 92408-3746 - Phone
- (909) 433-9911
- NPI assigned
- Apr 22, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 | AC 8676 | CA | Primary |
Addresses
Primary practice location
2160 S Waterman Ave Ste D
San Bernardino, CA 92408-3746
Mailing address
24244 Sylvan Glen Rd Unit F
Diamond Bar, CA 91765-4535
Phone (213) 999-3851
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AC 8676 | Other | CA | ACUPUNTURIST |
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 |
|---|---|---|---|
| AC 8676 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215155759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24244 SYLVAN GLEN RD UNIT F",
"city": "DIAMOND BAR",
"state": "CA",
"postal_code": "917654535",
"telephone_number": "213-999-3851",
"fax_number": "909-860-5577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2160 S WATERMAN AVE STE D",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924083746",
"telephone_number": "909-433-9911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JIYEON",
"name_prefix": "Miss",
"credential": "L.AC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC 8676",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACUPUNTURIST",
"identifier": "AC 8676",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.