MEDICARE: BYUM SUK KIM D.C

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	DC30749	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11901787	OTHER		CAQH

General Provider Information

NPI Number	:	1558544080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYUM SUK KIM D.C

Provider Business Mailing Address
First Line	:	3240 WILSHIRE BL
Second Line	:	#240
City	:	LOS ANGELES
State	:	CA
Zip	:	90010
Country	:	US
Telephone Number	:	213-365-0212
Fax Number	:	213-365-0480

Provider Business Practice Location Address
First Line	:	3240 WILSHIRE BL
Second Line	:	#240
City	:	LOS ANGELES
State	:	CA
Zip	:	90010
Country	:	US
Telephone Number	:	213-365-0212
Fax Number	:	213-365-0480

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

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	11/24/2008

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Directions to “ BYUM SUK KIM D.C” Practice Location

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