Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 32403 | CA |
NPI | 1164773800 |
---|---|
Provider Name | Dr. Jong H Kim |
First Address | Torrance, CA 90502-2347 |
Second Address | Torrance, CA 90505-7064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2012 |
Last Update Date | 01/06/2017 |