Healthcare Provider Details

I. General information

NPI: 1669220141
Provider Name (Legal Business Name): JAMES D KIM LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S BLACKSTOCK RD STE E
SPARTANBURG SC
29301-2578
US

IV. Provider business mailing address

313 POWELL MILL RD APT E
SPARTANBURG SC
29301-1538
US

V. Phone/Fax

Practice location:
  • Phone: 917-529-2275
  • Fax:
Mailing address:
  • Phone: 917-529-2275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number033337
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13771
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: