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General NPI Number Information
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NPI Number | 1902220619
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Entity Type | Organization
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Legal Business Name | RICHARD KIM CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 02/17/2014
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 2391 BELL BLVD STE 103
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City | BAYSIDE
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State | NY
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Zip | 11360-2019
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Country | US
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Telephone | 718-224-8382
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Fax | 718-224-2844
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Provider Business Mailing Address
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Address Line | 2391 BELL BLVD STE 103
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City | BAYSIDE
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State | NY
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Zip | 11360-2019
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Country | US
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Telephone | 718-224-8382
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Fax | 718-224-2488
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Authorized Official
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Title or Position | CHIROPRACTOR/ OWNER
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Name | DR. CHANG SUNG KIM
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Credential | D.C.
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Telephone | 410-493-8387
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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 | 012364
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License Number State | NY
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