Provider Demographics
NPI:1710044912
Name:KIM, HYEON JOO
Entity Type:Individual
Prefix:
First Name:HYEON
Middle Name:JOO
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 E 4370 S
Mailing Address - Street 2:SUITE 16
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-2624
Mailing Address - Country:US
Mailing Address - Phone:801-287-9559
Mailing Address - Fax:
Practice Address - Street 1:153 EAST 4370 SOUTH
Practice Address - Street 2:#16
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-2608
Practice Address - Country:US
Practice Address - Phone:801-287-9559
Practice Address - Fax:801-287-9559
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT50503621201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist