=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619167327
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIO KIM CHIROPRACTIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2007
-----------------------------------------------------
Last Update Date | 07/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 513 E 1ST ST SUITE A
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-3348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-505-1514
-----------------------------------------------------
Fax | 714-505-1513
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 513 E 1ST ST SUITE A
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-3348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-505-1514
-----------------------------------------------------
Fax | 714-505-1513
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/CLINIC DIRECTOR
-----------------------------------------------------
Name | DR. DIO KIM
-----------------------------------------------------
Credential | D.C., L.AC.
-----------------------------------------------------
Telephone | 714-505-1514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC10600
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC27994
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------