Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2002 | CT |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 2002 | CT |
NPI | 1144617242 |
---|---|
Provider Name | Hyun S Kim |
First Address | Bridgeport, CT 06604-7620 |
Second Address | Bridgeport, CT 06604-7620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2015 |
Last Update Date | 10/09/2015 |