Healthcare Provider Details

I. General information

NPI: 1851652382
Provider Name (Legal Business Name): DANIEL JIYONG KIM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 THE ALAMEDA SUITE 11
SAN JOSE CA
95126-5000
US

IV. Provider business mailing address

1354 THE ALAMEDA SUITE 11
SAN JOSE CA
95126-5000
US

V. Phone/Fax

Practice location:
  • Phone: 408-899-2288
  • Fax:
Mailing address:
  • Phone: 408-899-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCA-DC31865
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC31865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: