Healthcare Provider Details

I. General information

NPI: 1720559396
Provider Name (Legal Business Name): SOO JIN KIM CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25000 AVENUE STANFORD STE 174
VALENCIA CA
91355-4596
US

IV. Provider business mailing address

819 S ALVARADO ST STE 202
LOS ANGELES CA
90057-4085
US

V. Phone/Fax

Practice location:
  • Phone: 323-203-4414
  • Fax:
Mailing address:
  • Phone: 323-203-4414
  • Fax: 213-352-4069

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. SOO JIN JIN KIM
Title or Position: DOCTOR
Credential: DC, LAC
Phone: 323-203-4414