Provider Demographics
NPI:1679805832
Name:KIM, HYON CHOL (LAC)
Entity type:Individual
Prefix:
First Name:HYON
Middle Name:CHOL
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 1:3750 97TH ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1722
Mailing Address - Country:US
Mailing Address - Phone:917-656-6771
Mailing Address - Fax:
Practice Address - Street 1:3750 97TH ST APT 4E
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1722
Practice Address - Country:US
Practice Address - Phone:917-656-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004164171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist