Provider Demographics
NPI:1962270611
Name:KIM, NAYOUNG (LAC)
Entity type:Individual
Prefix:
First Name:NAYOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:160 S MAPLE AVE APT C5
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4533
Mailing Address - Country:US
Mailing Address - Phone:201-639-1099
Mailing Address - Fax:
Practice Address - Street 1:18 SYCAMORE AVE STE 2
Practice Address - Street 2:
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423-1500
Practice Address - Country:US
Practice Address - Phone:201-639-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00158000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist