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General NPI Number Information
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NPI Number | 1013284025
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Entity Type | Individual
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Provider Name | KIM DOAN LAC
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Gender | Female
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Dates
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Enumeration Date | 11/18/2011
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 220 MAIN ST S STE 205
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City | SOUTHBURY
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State | CT
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Zip | 06488-2275
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Country | US
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Telephone | 203-648-3333
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Fax | 203-405-0274
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Provider Business Mailing Address
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Address Line | 163 MINORTOWN RD
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City | WOODBURY
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State | CT
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Zip | 06798-3008
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Country | US
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Telephone | 203-263-6339
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000550
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License Number State | CT
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