Provider Demographics
NPI:1801240197
Name:KIM, KIHWAN
Entity type:Individual
Prefix:
First Name:KIHWAN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-2422
Mailing Address - Country:US
Mailing Address - Phone:212-567-5891
Mailing Address - Fax:
Practice Address - Street 1:4470 BROADWAY
Practice Address - Street 2:2ND FLOOR / STE2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2669
Practice Address - Country:US
Practice Address - Phone:212-567-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist