Healthcare Provider Details

I. General information

NPI: 1528175221
Provider Name (Legal Business Name): YOM & KIM, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 BROADWAY
ASTORIA NY
11103-2359
US

IV. Provider business mailing address

15301 NORTHERN BLVD. STE. 2G
FLUSHING NY
11354-5038
US

V. Phone/Fax

Practice location:
  • Phone: 718-888-1641
  • Fax: 718-888-2514
Mailing address:
  • Phone: 718-888-1641
  • Fax: 718-888-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001213
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003103
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number019722
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number024040
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberX009398
License Number StateNY

VIII. Authorized Official

Name: MR. DOHYUNG KIM
Title or Position: PRESIDENT
Credential: PT
Phone: 718-888-1641