Provider Demographics
NPI:1851500490
Name:KIM, ANDREW CHAEHWAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:CHAEHWAN
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:CHAEHWAN
Other - Middle Name:ANDREW
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:16 W 32ND ST STE 902
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-0907
Mailing Address - Country:US
Mailing Address - Phone:212-714-1444
Mailing Address - Fax:212-714-1441
Practice Address - Street 1:16 W 32ND ST STE 902
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-0907
Practice Address - Country:US
Practice Address - Phone:212-714-1444
Practice Address - Fax:212-714-1441
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001822171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist