Provider Demographics
NPI:1801370093
Name:KIM, JIN HYUN (LAC)
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:HYUN
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 ROUTE 100 STE 2
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-3259
Mailing Address - Country:US
Mailing Address - Phone:914-348-9448
Mailing Address - Fax:
Practice Address - Street 1:332 ROUTE 100 STE 2
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3259
Practice Address - Country:US
Practice Address - Phone:914-348-9448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006357171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist