Provider Demographics
NPI:1801532866
Name:KIM, ALEX K
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:K
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 1:1 SHORE LN APT 2210
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2087
Mailing Address - Country:US
Mailing Address - Phone:551-486-1446
Mailing Address - Fax:
Practice Address - Street 1:60 DUTCH HILL RD STE 2B
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1722
Practice Address - Country:US
Practice Address - Phone:845-570-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006920171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist