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Organization
KSJ ACUPUNCTURE CLINIC, INC.
Active
Organization
KSJ ACUPUNCTURE CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANG JO KIM DAOM, L.AC. (C.E.O.)
(760) 428-2800
Entity
Organization
Contact information
Practice address
12402 INDUSTRIAL BLVD STE B2, VICTORVILLE, CA 92395-5889
(760) 428-2800
(657) 255-4049
Mailing address
2150 CHEYENNE WAY UNIT 177, FULLERTON, CA 92833-4939
(760) 428-2800
(657) 255-4049
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC8143
ACUPUNCTURE LICENSE
CA
Enumeration date
06/25/2019
Last updated
06/25/2019
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