Healthcare Provider Details

I. General information

NPI: 1144490608
Provider Name (Legal Business Name): DR. KWANG E. KIM,D.C., PH.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 OAKWOOD AVE SUITE 100
LOS ANGELES CA
90004-2471
US

IV. Provider business mailing address

4711 OAKWOOD AVE SUITE 100
LOS ANGELES CA
90004-2471
US

V. Phone/Fax

Practice location:
  • Phone: 323-468-1001
  • Fax: 323-468-1080
Mailing address:
  • Phone: 323-468-1001
  • Fax: 323-468-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC11144
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC488
License Number StateCA

VIII. Authorized Official

Name: DR. KWANG E KIM
Title or Position: PRESIDENT
Credential: D.C.
Phone: 323-468-1001