Healthcare Provider Details

I. General information

NPI: 1982193355
Provider Name (Legal Business Name): YANGDONG KIM CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 CHINO HILLS PKWY STE 900
CHINO HILLS CA
91709-3784
US

IV. Provider business mailing address

4200 CHINO HILLS PKWY STE 900
CHINO HILLS CA
91709-3784
US

V. Phone/Fax

Practice location:
  • Phone: 714-296-2905
  • Fax:
Mailing address:
  • Phone: 714-296-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14488
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32153
License Number StateCA

VIII. Authorized Official

Name: DR. YANGDONG KIM
Title or Position: PRESIDENT
Credential: DC., DAOM., LAC.
Phone: 714-296-2905