Provider Demographics
NPI:1164103370
Name:KIM, JONG CHUL (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:JONG
Middle Name:CHUL
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3728
Mailing Address - Country:US
Mailing Address - Phone:717-333-3690
Mailing Address - Fax:
Practice Address - Street 1:70 WAVERLY AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3728
Practice Address - Country:US
Practice Address - Phone:717-333-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02853171100000X
PAAK001372171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist