Provider Demographics
NPI:1376886507
Name:KIM, JIN HAK (LAC)
Entity Type:Individual
Prefix:MR
First Name:JIN HAK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14 CANDLEWOOD LAKE RD
Mailing Address - Street 2:CANDLEWOOD SALON AND DAY SPA
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2529
Mailing Address - Country:US
Mailing Address - Phone:203-740-7600
Mailing Address - Fax:203-740-3616
Practice Address - Street 1:14 CANDLEWOOD LAKE RD
Practice Address - Street 2:CANDLEWOOD SALON AND DAY SPA
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2529
Practice Address - Country:US
Practice Address - Phone:203-740-7600
Practice Address - Fax:203-740-3616
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-06
Last Update Date:2013-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000527171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist