Provider Demographics
NPI:1891475349
Name:KIM, YEONG C
Entity Type:Individual
Prefix:
First Name:YEONG
Middle Name:C
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 1:98 MEADOWVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2041
Mailing Address - Country:US
Mailing Address - Phone:201-655-4500
Mailing Address - Fax:
Practice Address - Street 1:98 MEADOWVIEW CT
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-2041
Practice Address - Country:US
Practice Address - Phone:201-655-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00166400171100000X
NY007310171100000X
NJ18KT01455700225700000X
NY033138225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist