Provider Demographics
NPI:1538611736
Name:KIM, HUN (LAC)
Entity type:Individual
Prefix:
First Name:HUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10721 71ST AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4783
Mailing Address - Country:US
Mailing Address - Phone:718-715-9366
Mailing Address - Fax:
Practice Address - Street 1:10721 71ST AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4783
Practice Address - Country:US
Practice Address - Phone:718-715-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005331-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist