Provider Demographics
NPI:1528374477
Name:KIM, KWAN JOONG (L, AC)
Entity Type:Individual
Prefix:
First Name:KWAN JOONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:L, AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-0666
Mailing Address - Country:US
Mailing Address - Phone:843-757-7512
Mailing Address - Fax:843-757-7542
Practice Address - Street 1:23 PLANTATION PARK DR STE 203
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6072
Practice Address - Country:US
Practice Address - Phone:843-757-7512
Practice Address - Fax:843-757-7542
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist