Sang Jo Kim, L.AC.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC8143 Issued in CA

Practice address

12402 Industrial Blvd
Unit B2
Victorville, CA 92395-5871

Phone

(760) 428-2800

NPI assigned

May 17, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• KSJ Acupuncture Clinic, Inc.

  • Acupuncturist
  • Victorville, CA
  • NPI 1922669456
  NPD Authorized official
• KSJ Acupuncture Clinic

  • Acupuncturist
  • Victorville, CA
  • NPI 1275604522
  NPD (past) Authorized official

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1902013741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2150 CHEYENNE WAY",
            "address_2": "UNIT 177",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928334949",
            "telephone_number": "760-428-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12402 INDUSTRIAL BLVD",
            "address_2": "UNIT B2",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955871",
            "telephone_number": "760-428-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "SANG JO",
        "name_prefix": "Mr.",
        "credential": "L.AC.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "AC8143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "AC0081430",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0600841",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eman J Khan
• Abdelrahman Khater
• Jin-Hyuk Kim, D.D.S.
• Justine J Kim, FNP
• Kellee Kim
• Taejune Kim
• Yoonah Kim
• Tamara Lee Kimball
• Kimberly Moret Licensed Clinical Social Worker, PC
• Semetrah Alima Kincannon, M.S. CCC SLP

• Acupuncturist in Victorville, CA
• Providers in Victorville, CA by specialty
• Acupuncturist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; 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.