Active NPI
Shinwon Kim, LAC
- Acupuncturist
- San Jose, CA
National Provider Identifier
1578055653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC17555
- Practice address
- 4155 Moorpark Ave
Ste 20
San Jose, CA 95117 - Phone
- (866) 845-9589
- NPI assigned
- Jun 4, 2018
- Sex
- Male
- 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 | AC17555 | CA | Primary |
Addresses
Primary practice location
4155 Moorpark Ave
Ste 20
San Jose, CA 95117
Mailing address
4155 Moorpark Ave
Ste 20
San Jose, CA 95117
Phone (866) 845-9589
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 |
|---|---|---|---|
| AC17555 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528070400000",
"number": "1578055653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4155 MOORPARK AVE",
"address_2": "STE 20",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "95117",
"telephone_number": "866-845-9589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4155 MOORPARK AVE",
"address_2": "STE 20",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "95117",
"telephone_number": "866-845-9589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "SHINWON",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-06-04",
"last_updated": "2018-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC17555",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.