Healthcare Provider Details

I. General information

NPI: 1356325823
Provider Name (Legal Business Name): STANLEY KIM OH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 DAY ST
RIVERSIDE CA
92507-0901
US

IV. Provider business mailing address

6405 DAY ST
RIVERSIDE CA
92507-0901
US

V. Phone/Fax

Practice location:
  • Phone: 951-697-5572
  • Fax: 951-697-5579
Mailing address:
  • Phone: 951-697-5572
  • Fax: 951-697-5578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC25483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: