MEDICARE: DR. TAI YUN KIM D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC26634	CA

General Provider Information

NPI Number	:	1396863148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAI YUN KIM D.C.

Provider Business Mailing Address
First Line	:	1265 MONTECITO AVE STE 103
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-4581
Country	:	US
Telephone Number	:	650-938-5151
Fax Number	:	650-938-5153

Provider Business Practice Location Address
First Line	:	1265 MONTECITO AVE STE 103
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-4581
Country	:	US
Telephone Number	:	650-938-5151
Fax Number	:	650-938-5153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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