Provider Demographics
NPI:1962861898
Name:GIM, HUNG I (LAC)
Entity Type:Individual
Prefix:
First Name:HUNG
Middle Name:
Last Name:GIM
Suffix:I
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BEACH RD APT 3J
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1105
Mailing Address - Country:US
Mailing Address - Phone:917-683-8786
Mailing Address - Fax:
Practice Address - Street 1:15 BEACH RD APT 3J
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1105
Practice Address - Country:US
Practice Address - Phone:917-683-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-20
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005162171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist