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General NPI Number Information
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NPI Number | 1629478169
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Entity Type | Individual
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Provider Name | JINA KIM
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Gender | Female
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Dates
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Enumeration Date | 09/03/2014
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Last Update Date | 12/17/2014
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Provider Practice Location Address
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Address Line | 5675 RISING SUN AVE SUITE 14
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City | PHILADELPHIA
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State | PA
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Zip | 19120-2100
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Country | US
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Telephone | 404-483-0776
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Fax |
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Provider Business Mailing Address
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Address Line | 5675 RISING SUN AVE SUITE 14
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City | PHILADELPHIA
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State | PA
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Zip | 19120-2100
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Country | US
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Telephone | 404-483-0776
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Fax |
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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 | DC010935
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License Number State | PA
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