Provider Demographics
NPI:1013284025
Name:DOAN, KIM (LAC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:DOAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 MINORTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3008
Mailing Address - Country:US
Mailing Address - Phone:203-263-6339
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST S STE 205
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2275
Practice Address - Country:US
Practice Address - Phone:203-648-3333
Practice Address - Fax:203-405-0274
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000550171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist