Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | DC 32286 | CA |
NPI | 1285908673 |
---|---|
Provider Name | Jessica Kim |
First Address | Torrance, CA 90501-3406 |
Second Address | Upland, CA 91784-9179 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2012 |
Last Update Date | 26/10/2017 |