Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC009631 | PA |
N | 111NN1001X | Nutrition | AJ009433 | PA |
N | 111NR0400X | Rehabilitation Chiropractor | AJ009433 | PA |
N | 111NS0005X | Chiropractic Sports Physician | DC009631 | PA |
NPI | 1508084179 |
---|---|
Provider Name | Dr. William W. Kim |
First Address | Conshohocken, PA 19428-5400 |
Second Address | Blue Bell, PA 19422-1749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 24/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U99869 | (02) |