Provider Demographics
NPI:1699906107
Name:KIM, KYOUNGHEE (LAC)
Entity type:Individual
Prefix:
First Name:KYOUNGHEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 VALLEY AVE APT E2
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3608
Mailing Address - Country:US
Mailing Address - Phone:908-227-5034
Mailing Address - Fax:
Practice Address - Street 1:20 VALLEY AVE APT E2
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3608
Practice Address - Country:US
Practice Address - Phone:908-227-5034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003343171100000X
NJ25MZ00054400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist