Provider Demographics
NPI:1780224766
Name:KIM, JOHN SHINWON (LAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SHINWON
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 1:26 CITATION DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4661
Mailing Address - Country:US
Mailing Address - Phone:908-907-1282
Mailing Address - Fax:
Practice Address - Street 1:80 MAIDEN LN RM 1007
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4764
Practice Address - Country:US
Practice Address - Phone:212-386-7812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006661171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist