=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689116063
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW YORK KYUNGHEE ACUPUNCTURE KIM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2016
-----------------------------------------------------
Last Update Date | 11/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6650 BELAIR RD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21206-1874
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-522-1666
-----------------------------------------------------
Fax | 646-869-2793
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 WEST 32ND STREET #6FL
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-522-1666
-----------------------------------------------------
Fax | 646-869-2793
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAE HYUN KIM
-----------------------------------------------------
Credential | L.AC
-----------------------------------------------------
Telephone | 646-522-1666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | U02331
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------