Provider Demographics
NPI:1922591106
Name:KIM, JONG SIN
Entity Type:Individual
Prefix:MR
First Name:JONG
Middle Name:SIN
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 1:14226 37TH AVE STE C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4368
Mailing Address - Country:US
Mailing Address - Phone:718-353-7575
Mailing Address - Fax:718-353-7577
Practice Address - Street 1:14226 37TH AVE STE C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4368
Practice Address - Country:US
Practice Address - Phone:171-835-3757
Practice Address - Fax:718-353-7577
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004027171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty