Provider Demographics
NPI:1306033055
Name:KIM, JOHN KWANG (L AC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KWANG
Last Name:KIM
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:KWANG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC
Mailing Address - Street 1:3731 149TH ST STE NORTH
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4832
Mailing Address - Country:US
Mailing Address - Phone:718-321-2511
Mailing Address - Fax:
Practice Address - Street 1:3731 149TH ST STE NORTH
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4832
Practice Address - Country:US
Practice Address - Phone:718-321-2511
Practice Address - Fax:888-327-6892
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003391-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist