Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC30142 | CA |
NPI | 1003071663 |
---|---|
Provider Name | Sang Eon Kim |
First Address | Sunnyvale, CA 94087-1977 |
Second Address | Sunnyvale, CA 94087-1977 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2008 |
Last Update Date | 17/01/2017 |