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General NPI Number Information
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NPI Number | 1215734884
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Entity Type | Individual
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Provider Name | ANN KIM LAC
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Gender | Female
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 190 CHRISTOPHER COLUMBUS DR STE 3A
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City | JERSEY CITY
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State | NJ
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Zip | 07302-3432
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Country | US
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Telephone | 201-724-3998
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Fax |
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Provider Business Mailing Address
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Address Line | 51 QUEEN ANNE RD APT 401
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City | BOGOTA
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State | NJ
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Zip | 07603-1817
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Country | US
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Telephone | 678-717-8575
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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 | 25MZ00175500
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License Number State | NJ
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