1003130550 NPI number — WOO S KIM CHIROPRACTIC REHAB THERAPY A PROF CORP

Table of content: MARK EDWARD HOLLIDAY OD (NPI 1457304701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003130550 NPI number — WOO S KIM CHIROPRACTIC REHAB THERAPY A PROF CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOO S KIM CHIROPRACTIC REHAB THERAPY A PROF CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003130550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2120 W 8TH ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90057-4082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-483-3987
Provider Business Mailing Address Fax Number:
213-483-5547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 W 8TH ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-4082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-483-3987
Provider Business Practice Location Address Fax Number:
213-483-5547
Provider Enumeration Date:
03/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
WOO
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
213-483-3987

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC27464 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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