Healthcare Provider Details

I. General information

NPI: 1962945204
Provider Name (Legal Business Name): JAE MIN KIM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 LIVINGSTON ST STE T
NORTHVALE NJ
07647-1916
US

IV. Provider business mailing address

271 LIVINGSTON ST STE T
NORTHVALE NJ
07647-1916
US

V. Phone/Fax

Practice location:
  • Phone: 201-820-8600
  • Fax:
Mailing address:
  • Phone: 201-820-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00756500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX012718-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: