Provider Demographics
NPI:1528175221
Name:YOM & KIM, LLC.
Entity type:Organization
Organization Name:YOM & KIM, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOHYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-888-1641
Mailing Address - Street 1:15301 NORTHERN BLVD.
Mailing Address - Street 2:STE. 2G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5038
Mailing Address - Country:US
Mailing Address - Phone:718-888-1641
Mailing Address - Fax:718-888-2514
Practice Address - Street 1:4301 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-2359
Practice Address - Country:US
Practice Address - Phone:718-888-1641
Practice Address - Fax:718-888-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001213171100000X
NY003103171100000X
NY019722174400000X
NY024040174400000X
NYX009398111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02588576Medicaid
NY02590958Medicaid
NY04661Medicare ID - Type UnspecifiedDOHYUNG KIM
NY04261Medicare ID - Type UnspecifiedJONG WON YOM