Provider Demographics
NPI:1194044255
Name:KIM, HYUNGWOOK (LAC)
Entity Type:Individual
Prefix:MR
First Name:HYUNGWOOK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3609
Mailing Address - Country:US
Mailing Address - Phone:212-729-3785
Mailing Address - Fax:973-404-8803
Practice Address - Street 1:426 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3609
Practice Address - Country:US
Practice Address - Phone:212-729-3785
Practice Address - Fax:973-404-8803
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00060600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist