Provider Demographics
NPI:1942658489
Name:KIM, YONG (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:YONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13195 WARWICK BLVD
Mailing Address - Street 2:SUITE # 1D
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-8312
Mailing Address - Country:US
Mailing Address - Phone:757-898-0200
Mailing Address - Fax:
Practice Address - Street 1:13195 WARWICK BLVD
Practice Address - Street 2:SUITE # 1D
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-8312
Practice Address - Country:US
Practice Address - Phone:757-898-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121 000086171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist