Provider Demographics
NPI:1578270633
Name:KIM, HYOSEONG (LAC)
Entity Type:Individual
Prefix:
First Name:HYOSEONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3447 59TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2127
Mailing Address - Country:US
Mailing Address - Phone:718-749-3845
Mailing Address - Fax:
Practice Address - Street 1:3518 150TH PL FL 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4922
Practice Address - Country:US
Practice Address - Phone:718-445-4370
Practice Address - Fax:718-445-4378
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006694171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist