Healthcare Provider Details

I. General information

NPI: 1538538616
Provider Name (Legal Business Name): STEVE KIM CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 E CHAPMAN AVE SUITE 2
FULLERTON CA
92831-4141
US

IV. Provider business mailing address

1950 E CHAPMAN AVE SUITE 2
FULLERTON CA
92831-4141
US

V. Phone/Fax

Practice location:
  • Phone: 714-525-5766
  • Fax: 714-525-5986
Mailing address:
  • Phone: 714-525-5766
  • Fax: 714-525-5986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC29934
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC11610
License Number StateCA

VIII. Authorized Official

Name: STEVE SEUNGTAE KIM
Title or Position: PRESIDENT
Credential: D.C.
Phone: 714-525-5766