Provider Demographics
NPI:1275969644
Name:KIM, HYONG R (LAC)
Entity Type:Individual
Prefix:MS
First Name:HYONG
Middle Name:R
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:1590 ANDERSON AVE APT 2H
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2707
Mailing Address - Country:US
Mailing Address - Phone:201-835-0173
Mailing Address - Fax:
Practice Address - Street 1:140 PROSPECT AVE
Practice Address - Street 2:2ND FLR SUITE 16
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-835-0173
Practice Address - Fax:201-429-2363
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00101700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist