MEDICARE: DR. JOHN KWANG KIM L. AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	003391-1	NY

General Provider Information

NPI Number	:	1306033055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN KWANG KIM L. AC.

Provider Business Mailing Address
First Line	:	3731 149TH ST STE NORTH
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-4832
Country	:	US
Telephone Number	:	718-321-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	3731 149TH ST STE NORTH
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11354-4832
Country	:	US
Telephone Number	:	718-321-2511
Fax Number	:	888-327-6892

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2007
Last Update Date	:	01/30/2015

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