Healthcare Provider Details

I. General information

NPI: 1619167327
Provider Name (Legal Business Name): DIO KIM CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 E 1ST ST SUITE A
TUSTIN CA
92780-3348
US

IV. Provider business mailing address

513 E 1ST ST SUITE A
TUSTIN CA
92780-3348
US

V. Phone/Fax

Practice location:
  • Phone: 714-505-1514
  • Fax: 714-505-1513
Mailing address:
  • Phone: 714-505-1514
  • Fax: 714-505-1513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27994
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10600
License Number StateCA

VIII. Authorized Official

Name: DR. DIO KIM
Title or Position: CEO/CLINIC DIRECTOR
Credential: D.C., L.AC.
Phone: 714-505-1514