Healthcare Provider Details

I. General information

NPI: 1982006730
Provider Name (Legal Business Name): JAY KYU RIM LAC LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 8TH AVE SUITE 1304
NEW YORK NY
10011-5126
US

IV. Provider business mailing address

4915 BROADWAY APT 4B
NEW YORK NY
10034-3119
US

V. Phone/Fax

Practice location:
  • Phone: 347-620-6206
  • Fax:
Mailing address:
  • Phone: 347-620-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number021016
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number005378
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: