SU GYM KIM (Credential# 1609884) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is July 1, 2020. The license expiration date date is June 30, 2021. The license status is ACTIVE.
SU GYM KIM is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.062283. The credential type is physician/surgeon. The effective date is July 1, 2020. The expiration date is June 30, 2021. The business address is 912 Highcroft Pl, Weatogue, CT 06089-7920. The current status is active.
| Licensee Name | SU GYM KIM |
| Credential ID | 1609884 |
| Credential Number | 1.062283 |
| Credential Type | Physician/Surgeon |
| Business Address |
912 Highcroft Pl Weatogue CT 06089-7920 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2019-01-17 |
| Effective Date | 2020-07-01 |
| Expiration Date | 2021-06-30 |
| Refresh Date | 2020-06-02 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1627270 | CSP.0070126 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2019-01-22 | 2019-01-22 - 2021-02-28 | ACTIVE |
| Street Address | 912 HIGHCROFT PL |
| City | WEATOGUE |
| State | CT |
| Zip Code | 06089-7920 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Leah M Storti | 906 Highcroft Pl, Weatogue, CT 06089-7920 | Speech and Language Pathologist | 2020-07-01 ~ 2021-06-30 |
| Arturo Federico | 913 Highcroft Pl, Weatogue, CT 06089-7920 | Controlled Substance Registration for Practitioner | 2019-05-24 ~ 2021-02-28 |
| Annette C Lilly | 901 Highcroft Pl, Weatogue, CT 06089-7920 | Hairdresser/cosmetician | 2018-08-01 ~ 2020-07-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Amanda Ogrin | 24 Alan Drive, Weatogue, CT 06089 | Professional Counselor Associate | ~ |
| Joseph A Galiette | 283 Hopmeadow St, Weatogue, CT 06089 | Hairdresser/cosmetician | 2020-07-01 ~ 2022-06-30 |
| Xia Gao | 145 Cooper Ave Unit16, Weatogue, CT 06089 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Gary J Guimond | 63 Hilltop Dr, Weatogue, CT 06089 | Landscape Architect | 2020-08-01 ~ 2021-07-31 |
| Elizabeth J Langevin | 21 Sand Hill Rd, Weatogue, CT 06089 | Licensed Clinical Social Worker | 2020-08-01 ~ 2021-07-31 |
| Samuel D. Buonocore | 7 Caryn Ln, Weatogue, CT 06089 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Trent Tao She | 3 Cooper Avenue, Weatogue, CT 06089 | Physician/surgeon | 2020-06-01 ~ 2021-05-31 |
| Hiu Lui Yeung | 84 Simsbury Manor Dr, Weatogue, CT 06089 | Nail Technician | 2020-06-23 ~ 2022-03-31 |
| Xiangyu Dong | 20 Hopmeadow St Unit 426, Weatogue, CT 06089 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Arielle H Marlette | 81 Cooper Avenue, Simsbury, CT 06089 | Advanced Practice Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Find all Licenses in zip 06089 | |||
| City | WEATOGUE |
| Zip Code | 06089 |
| License Type | Physician/Surgeon |
| License Type + County | Physician/Surgeon + WEATOGUE |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Russell H Harris Md | Envision Physician Services, Horsham, PA 19044 | Physician/surgeon | 2019-09-01 ~ 2020-08-31 |
| Gilbert L Drozdow | Envision Physician Services, Plantation, FL 33322 | Physician/surgeon | 2019-10-01 ~ 2020-09-30 |
| Penny Lamhut Md | Genesis Physician Services, Windsor, CT 06098 | Physician/surgeon | 1999-07-15 ~ 2000-07-31 |
| Arnold R Kriegstein | College Physician, New York, NY 10032 | Physician/surgeon | 1993-04-23 ~ 1994-03-31 |
| John T Thompson | Physician Pavilion W, Towson, MD 21204 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
| Brent Robert Jacobson | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-09-01 ~ 2021-08-31 |
| Catherine Nguyen Keegan | Envision Physician Services, Dallas, TX 75240 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
| Nazanin Barzideh Md | North Shore Retina Physician, Pllc, East Hills, NY 11576 | Physician/surgeon | 2010-05-01 ~ 2011-04-30 |
| Barbara M Galko Md | Danbury Office of Physician Services PC, Danbury, CT 06810 | Physician/surgeon | 2010-06-01 ~ 2011-05-31 |
| Barbara A Brandes Md | Danbury Office of Physician Services, Danbury, CT 06810 | Physician/surgeon | 2004-07-08 ~ 2005-07-31 |
Please comment or provide details below to improve the information on SU GYM KIM.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).