MEDICARE: KIM Y YOO DC

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	111NN1001X	Nutrition Chiropractor	004765	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528023272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM Y YOO DC

Provider Business Mailing Address
First Line	:	1135 W CHELTENHAM AVE
Second Line	:	#1
City	:	MELROSE PARK
State	:	PA
Zip	:	19027-3008
Country	:	US
Telephone Number	:	215-782-3135
Fax Number	:	215-782-3134

Provider Business Practice Location Address
First Line	:	1135 W CHELTENHAM AVE
Second Line	:	#1
City	:	MELROSE PARK
State	:	PA
Zip	:	19027-3008
Country	:	US
Telephone Number	:	215-782-3135
Fax Number	:	215-782-3134

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/08/2007

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Directions to “ KIM Y YOO DC” Practice Location

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