MEDICARE: KENNETH YONG KIM DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104557520	VA

General Provider Information

NPI Number	:	1447630322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH YONG KIM DC

Provider Business Mailing Address
First Line	:	6225 BRANDON AVE
Second Line	:	STE 175
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-2519
Country	:	US
Telephone Number	:	253-533-4140
Fax Number	:

Provider Business Practice Location Address
First Line	:	6225 BRANDON AVE STE 175
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-2519
Country	:	US
Telephone Number	:	253-533-4140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	08/11/2025

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