=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225121882
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIO D KIM D.C., L. AC.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 03/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14232 RED HILL AVE
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-5836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-505-5252
-----------------------------------------------------
Fax | 714-505-1513
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14232 RED HILL AVE
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-3348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-505-5252
-----------------------------------------------------
Fax | 714-505-1513
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC27994
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC10600
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------