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General NPI Number Information
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NPI Number | 1790922391
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Entity Type | Organization
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Legal Business Name | DR KIM CHIROPRACTIC A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/19/2009
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 650 S WESTLAKE BLVD STE 200
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-3885
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Country | US
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Telephone | 805-777-8154
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Fax | 805-777-8157
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Provider Business Mailing Address
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Address Line | 650 S WESTLAKE BLVD STE 200
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91362-3885
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Country | US
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Telephone | 805-777-8154
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Fax | 805-777-8157
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Authorized Official
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Title or Position | PRESIDENT
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Name | KAP R KIM
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Credential | D.C., LA.C
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Telephone | 805-777-8154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC12636
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC22741
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License Number State | CA
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