Provider Demographics
NPI:1467573097
Name:KIM, MIYANG
Entity Type:Individual
Prefix:DR
First Name:MIYANG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E 86TH ST
Mailing Address - Street 2:SUITE 20-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6400
Mailing Address - Country:US
Mailing Address - Phone:212-502-8900
Mailing Address - Fax:516-299-5282
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5711
Practice Address - Country:US
Practice Address - Phone:201-242-9001
Practice Address - Fax:516-299-5282
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001480-1171100000X
NJ25MZ00037200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6292349OtherACUPUNCTURIST
NJ25MZ00037200OtherACUPUNCTURIST