Provider Demographics
NPI:1558809186
Name:KIM, JONGHWI (DC)
Entity Type:Individual
Prefix:DR
First Name:JONGHWI
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MONMOUTH DR STE 303
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5716
Mailing Address - Country:US
Mailing Address - Phone:302-434-0101
Mailing Address - Fax:
Practice Address - Street 1:15280 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2800
Practice Address - Country:US
Practice Address - Phone:347-467-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor