Healthcare Provider Details

I. General information

NPI: 1558734921
Provider Name (Legal Business Name): EUN KIM CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2015
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 ATLAS STREET SUITE A
BREA CA
92821
US

IV. Provider business mailing address

13240 ABANA PLACE
CERRITOS CA
90703
US

V. Phone/Fax

Practice location:
  • Phone: 714-494-9355
  • Fax:
Mailing address:
  • Phone: 714-494-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16209
License Number StateCA

VIII. Authorized Official

Name: EUN CHA KIM
Title or Position: PRESIDENT
Credential: D.C., L.AC
Phone: 714-494-9355