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General NPI Number Information
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NPI Number | 1619610672
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Entity Type | Individual
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Provider Name | LYDIA KIM L.AC.
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Gender | Female
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Dates
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Enumeration Date | 04/18/2022
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 216 WILLIS AVE. SUITE 001
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577-2125
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Country | US
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Telephone | 917-747-4601
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Fax |
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Provider Business Mailing Address
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Address Line | 5311 FRANCIS LEWIS BLVD
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-1632
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Country | US
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Telephone |
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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 | 229N00000X
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Taxonomy Name | Anaplastologist
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License Number | 007035-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 007035-01
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License Number State | NY
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