MEDICARE: NANCHU 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	111NR0400X	Rehabilitation Chiropractor	DC28106	CA

General Provider Information

NPI Number	:	1932324233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCHU KIM D.C.

Provider Business Mailing Address
First Line	:	3251 W 6TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-5023
Country	:	US
Telephone Number	:	213-637-0171
Fax Number	:

Provider Business Practice Location Address
First Line	:	3251 W 6TH ST STE 107
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-5020
Country	:	US
Telephone Number	:	213-637-0171
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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