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General NPI Number Information
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NPI Number | 1285037689
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Entity Type | Individual
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Provider Name | KYUNGHWAN AN D.C
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Gender | Male
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 12121 BLUE RIDGE BLVD SUITE O
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City | GRANDVIEW
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State | MO
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Zip | 64030-1723
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Country | US
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Telephone | 816-217-0020
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Fax | 816-469-5325
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Provider Business Mailing Address
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Address Line | 12121 BLUE RIDGE EXT STE A
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City | GRANDVIEW
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State | MO
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Zip | 64030-1103
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Country | US
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Telephone | 816-217-0020
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Fax | 816-469-5325
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2013013772
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 2013013772
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License Number State | MO
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