Provider Demographics
NPI:1487070132
Name:KIM, HYOUNG GYO
Entity type:Individual
Prefix:
First Name:HYOUNG GYO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-1035
Mailing Address - Country:US
Mailing Address - Phone:917-968-3335
Mailing Address - Fax:
Practice Address - Street 1:800 2ND AVE
Practice Address - Street 2:SUITE 900
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4709
Practice Address - Country:US
Practice Address - Phone:646-710-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001676171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist