Provider Demographics
NPI:1598946097
Name:KIM, KATHERINE ECHO (MS, LAC)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ECHO
Last Name:KIM
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SYLVAN RD S STE F
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4637
Mailing Address - Country:US
Mailing Address - Phone:203-451-9865
Mailing Address - Fax:
Practice Address - Street 1:25 SYLVAN RD S STE F
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4637
Practice Address - Country:US
Practice Address - Phone:203-451-9865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-26
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT396171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist