Provider Demographics
NPI:1255534962
Name:KOJIMA, AILIN (LAC)
Entity type:Individual
Prefix:MS
First Name:AILIN
Middle Name:
Last Name:KOJIMA
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 1:240 W 102ND ST
Mailing Address - Street 2:APT. 55
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4900
Mailing Address - Country:US
Mailing Address - Phone:917-859-7506
Mailing Address - Fax:
Practice Address - Street 1:135 W 29TH ST RM 1103
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5224
Practice Address - Country:US
Practice Address - Phone:917-859-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003548171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist