Jaeyeal Kim, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

25MZ00168800 Issued in NJ

Practice address

576 Bergen Blvd Ste D
Ridgefield, NJ 07657-2042

Phone

(551) 451-9360

NPI assigned

Mar 20, 2024

Last updated

Mar 20, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sportsmed PT LLC

  • Physical Therapist
  • Glen Rock, NJ
  • NPI 1841787645

  Acupuncturist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1043070626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 BERGEN BLVD STE D",
            "city": "RIDGEFIELD",
            "state": "NJ",
            "postal_code": "076572042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 BERGEN BLVD STE D",
            "city": "RIDGEFIELD",
            "state": "NJ",
            "postal_code": "076572042",
            "telephone_number": "551-451-9360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JAEYEAL",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-20",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NJ",
            "license": "25MZ00168800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samerh M Khalil
• Jane Kyunghee Kim-Jin, L.AC
• Chan-Kyu Kim, DMD
• Dongkyun Daniel Kim, D.D.S.
• Esther Kim
• Jinsang Kim, D.D.S., M.A.
• Kind ABA LLC
• Lauren Marie Krolick, LPC
• Regina Krug, P.T.
• Hyuk Y Kwon, L.AC

• Acupuncturist in Ridgefield, NJ
• Providers in Ridgefield, NJ by specialty
• Acupuncturist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.