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General NPI Number Information
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NPI Number | 1265812309
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Entity Type | Organization
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Legal Business Name | KI TAE KIM CHIROPRACTIC INC.
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 2211 MOORPARK AVE SUITE 280
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City | SAN JOSE
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State | CA
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Zip | 95128-2654
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Country | US
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Telephone | 408-829-3019
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Fax | 888-734-8668
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Provider Business Mailing Address
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Address Line | 2211 MOORPARK AVE SUITE 280
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City | SAN JOSE
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State | CA
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Zip | 95128-2654
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Country | US
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Telephone | 408-829-3019
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Fax | 888-734-8668
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Authorized Official
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Title or Position | OWNER
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Name | KI TAE KIM
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Credential | D.C.
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Telephone | 408-829-3019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | DC27786
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License Number State | CA
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