Provider Demographics
NPI:1639837529
Name:KIBONE LLC
Entity Type:Organization
Organization Name:KIBONE LLC
Other - Org Name:DODAM ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZECHARIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURIST
Authorized Official - Phone:718-216-4115
Mailing Address - Street 1:6325 WOODSIDE CT STE 130
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3214
Mailing Address - Country:US
Mailing Address - Phone:443-941-5991
Mailing Address - Fax:
Practice Address - Street 1:6325 WOODSIDE CT STE 130
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3214
Practice Address - Country:US
Practice Address - Phone:443-941-5991
Practice Address - Fax:443-300-0678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center