Provider Demographics
NPI:1154655249
Name:KIM, DOAM (LAC)
Entity Type:Individual
Prefix:DR
First Name:DOAM
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 MAIN ST
Mailing Address - Street 2:#B
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6922
Mailing Address - Country:US
Mailing Address - Phone:201-585-8285
Mailing Address - Fax:201-585-8290
Practice Address - Street 1:166 MAIN ST
Practice Address - Street 2:#B
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6922
Practice Address - Country:US
Practice Address - Phone:201-585-8285
Practice Address - Fax:201-585-8290
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMZ00016800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist