Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC27463 | CA |
N | 111NR0200X | Radiology | DC27463 | CA |
N | 213ER0200X | Radiology | DC27463 | CA |
NPI | 1881637486 |
---|---|
Provider Name | Dr. Seog Woo Kim |
First Address | Granada Hills, CA 91344-6329 |
Second Address | Granada Hills, CA 91344-6329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 19/02/2015 |