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General NPI Number Information
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NPI Number | 1912286238
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Entity Type | Organization
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Legal Business Name | DAN HAKJAE KIM, A PROFESSIONAL CHIROPRACTIC CORP
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 31105 RANCHO VIEJO RD C9
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1717
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Country | US
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Telephone | 949-240-6196
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Fax | 949-240-9216
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Provider Business Mailing Address
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Address Line | 31105 RANCHO VIEJO RD C9
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-1717
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Country | US
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Telephone | 949-240-6196
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Fax | 949-240-9216
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Authorized Official
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Title or Position | DOCTOR
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Name | DAN HAKJAE KIM
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Credential | D.C.
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Telephone | 949-240-6196
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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 | 27679
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License Number State | CA
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