Provider Demographics
NPI:1962677153
Name:KANG, JIMO (LAC, PHD)
Entity Type:Individual
Prefix:
First Name:JIMO
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:34 W 32ND ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3800
Mailing Address - Country:US
Mailing Address - Phone:212-629-3927
Mailing Address - Fax:212-279-8585
Practice Address - Street 1:34 W 32ND ST
Practice Address - Street 2:SUITE 601
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3800
Practice Address - Country:US
Practice Address - Phone:212-629-3927
Practice Address - Fax:212-279-8585
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003453-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist