Healthcare Provider Details

I. General information

NPI: 1528023272
Provider Name (Legal Business Name): KIM Y YOO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 W CHELTENHAM AVE #1
MELROSE PARK PA
19027-3008
US

IV. Provider business mailing address

1135 W CHELTENHAM AVE #1
MELROSE PARK PA
19027-3008
US

V. Phone/Fax

Practice location:
  • Phone: 215-782-3135
  • Fax: 215-782-3134
Mailing address:
  • Phone: 215-782-3135
  • Fax: 215-782-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number004765
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: