Healthcare Provider Details

I. General information

NPI: 1144455627
Provider Name (Legal Business Name): HYUNG SUK KIM CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 W OLYMPIC BLVD STE 204
LOS ANGELES CA
90019-3563
US

IV. Provider business mailing address

3511 W OLYMPIC BLVD STE 204
LOS ANGELES CA
90019-3563
US

V. Phone/Fax

Practice location:
  • Phone: 323-733-1200
  • Fax:
Mailing address:
  • Phone: 323-733-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC30235
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 11861
License Number StateCA

VIII. Authorized Official

Name: DR. JONATHAN HYUNGSUK KIM
Title or Position: C.E.O
Credential: D.C., L.AC.
Phone: 323-733-1200