1144490608 NPI number — DR. KWANG E. KIM,D.C., PH.D.,INC.

Table of content: (NPI 1144490608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144490608 NPI number — DR. KWANG E. KIM,D.C., PH.D.,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. KWANG E. KIM,D.C., PH.D.,INC.
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:
1144490608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4711 OAKWOOD AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90004-2471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-468-1001
Provider Business Mailing Address Fax Number:
323-468-1080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4711 OAKWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90004-2471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-468-1001
Provider Business Practice Location Address Fax Number:
323-468-1080
Provider Enumeration Date:
03/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
KWANG
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
323-468-1001

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC11144 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: AC488 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8755512 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AC0004880 . This is a "ACUPUNCTURIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: DC11144 . This is a "CHIROPRACTOR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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