Provider Demographics
NPI:1538829049
Name:TAEYONG KIM ACUPUNCTURE PC
Entity type:Organization
Organization Name:TAEYONG KIM ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAEYONG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-815-1269
Mailing Address - Street 1:9115 LAMONT AVE APT 2K
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2731
Mailing Address - Country:US
Mailing Address - Phone:516-621-7072
Mailing Address - Fax:
Practice Address - Street 1:91 SEARINGTOWN RD
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1125
Practice Address - Country:US
Practice Address - Phone:516-621-7072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty