1881079861 NPI number — KIM DYNAMIC BODY CHIROPRACTIC, P.C.

Table of content: AMANDA JEAN POYNTER PTA (NPI 1508330259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881079861 NPI number — KIM DYNAMIC BODY CHIROPRACTIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIM DYNAMIC BODY CHIROPRACTIC, P.C.
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:
6
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:
1881079861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1354 THE ALAMEDA
Provider Second Line Business Mailing Address:
#11
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95126-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-899-2288
Provider Business Mailing Address Fax Number:
408-982-5211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1354 THE ALAMEDA
Provider Second Line Business Practice Location Address:
#11
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95126-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-899-2288
Provider Business Practice Location Address Fax Number:
408-982-5211
Provider Enumeration Date:
07/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
JIYONG
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
408-899-2288

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC31865 , 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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