Provider Demographics
NPI:1528390614
Name:KIM, DOHYUN (LAC, DAOM)
Entity Type:Individual
Prefix:MR
First Name:DOHYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC, DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ESSEX ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 ESSEX ST
Practice Address - Street 2:SUITE 222
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4036
Practice Address - Country:US
Practice Address - Phone:201-546-7290
Practice Address - Fax:201-678-2929
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00046000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist