Provider Demographics
NPI:1881971281
Name:KIM, DONG JIN (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:DONG JIN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:DON
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18 SYCAMORE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423-1582
Mailing Address - Country:US
Mailing Address - Phone:201-857-0888
Mailing Address - Fax:
Practice Address - Street 1:18 SYCAMORE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1582
Practice Address - Country:US
Practice Address - Phone:201-857-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004661171100000X
NJ25MZ00090100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist