Healthcare Provider Details

I. General information

NPI: 1447714019
Provider Name (Legal Business Name): OLYMPIA MSC KIM CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3544 W OLYMPIC BLVD STE 202
LOS ANGELES CA
90019-3532
US

IV. Provider business mailing address

3544 W OLYMPIC BLVD STE 202
LOS ANGELES CA
90019-3532
US

V. Phone/Fax

Practice location:
  • Phone: 323-733-8765
  • Fax: 323-733-2564
Mailing address:
  • Phone: 323-733-8765
  • Fax: 323-733-2564

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 Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL H KIM
Title or Position: PRESIDENT
Credential: D.C., L.AC
Phone: 323-733-8765