Provider Demographics
NPI:1730326422
Name:KIM, JUN S (LAC)
Entity type:Individual
Prefix:
First Name:JUN
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CLOSTER DOCK RD
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1928
Mailing Address - Country:US
Mailing Address - Phone:201-658-4225
Mailing Address - Fax:201-768-0255
Practice Address - Street 1:200 CLOSTER DOCK RD
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1928
Practice Address - Country:US
Practice Address - Phone:201-658-4225
Practice Address - Fax:201-768-0255
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00043100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist