Provider Demographics
NPI:1700135480
Name:KIM, KYOUNG HWAN (L AC)
Entity type:Individual
Prefix:
First Name:KYOUNG
Middle Name:HWAN
Last Name:KIM
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7901 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1301
Mailing Address - Country:US
Mailing Address - Phone:410-294-9499
Mailing Address - Fax:410-497-1113
Practice Address - Street 1:7901 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1301
Practice Address - Country:US
Practice Address - Phone:410-294-9499
Practice Address - Fax:410-497-1113
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000521171100000X
MDU01518171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist