Provider Demographics
NPI:1407332752
Name:KIM, RAYMOND (ACUPUNCTURE)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL PARK DR STE 7
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1966
Mailing Address - Country:US
Mailing Address - Phone:845-688-1030
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK DR STE 7
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1966
Practice Address - Country:US
Practice Address - Phone:201-206-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006188171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist