Provider Demographics
NPI:1588893523
Name:KIM, DONGHO (L AC)
Entity type:Individual
Prefix:
First Name:DONGHO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 KINGS HWY N STE 101
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1906
Mailing Address - Country:US
Mailing Address - Phone:856-667-3018
Mailing Address - Fax:
Practice Address - Street 1:1020 KINGS HWY N STE 101
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1906
Practice Address - Country:US
Practice Address - Phone:856-667-3018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00067900171100000X
PAAK000961171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist