MEDICARE: DR. STEPHEN Y 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	DC 24449	CA

General Provider Information

NPI Number	:	1508152133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN Y KIM D.C.

Provider Business Mailing Address
First Line	:	11326 CREEKSTONE LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-6329
Country	:	US
Telephone Number	:	858-717-6120
Fax Number	:	858-565-4377

Provider Business Practice Location Address
First Line	:	7750 DAGGET ST
Second Line	:	SUITE 105
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-2234
Country	:	US
Telephone Number	:	858-717-6120
Fax Number	:	858-565-4377

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

Provider Enumeration Date	:	06/22/2011
Last Update Date	:	06/24/2013

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