Provider Demographics
NPI:1124350376
Name:KIM, KIL HWAN (LAC)
Entity type:Individual
Prefix:MR
First Name:KIL HWAN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-4035
Mailing Address - Country:US
Mailing Address - Phone:646-483-9733
Mailing Address - Fax:
Practice Address - Street 1:1519 IRVING ST
Practice Address - Street 2:
Practice Address - City:RAHWAY
Practice Address - State:NJ
Practice Address - Zip Code:07065-4035
Practice Address - Country:US
Practice Address - Phone:646-483-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002928-1171100000X
NJ25MZ00064200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist