Provider Demographics
NPI:1982006730
Name:RIM, JAY KYU (LAC LMT)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:KYU
Last Name:RIM
Suffix:
Gender:M
Credentials:LAC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 BROADWAY
Mailing Address - Street 2:APT 4B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3119
Mailing Address - Country:US
Mailing Address - Phone:347-620-6206
Mailing Address - Fax:
Practice Address - Street 1:80 8TH AVE
Practice Address - Street 2:SUITE 1304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5126
Practice Address - Country:US
Practice Address - Phone:347-620-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021016225700000X
NY005378171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY25.005378OtherNYSED OFFICE OF PROFESSIONS DEPT.LICENSE#