MEDICARE: DONG SUK 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	111NR0400X	Rehabilitation Chiropractor	14959	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38MC00698300	OTHER	NJ	CHIROPRACTIC LICENSE
2	X012405-01	OTHER	NY	CHIROPRACTIC LICENSE
3	14959	OTHER	TX	CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1750655031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONG SUK KIM D.C.

Provider Business Mailing Address
First Line	:	PO BOX 700688
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78270-0688
Country	:	US
Telephone Number	:	210-318-3007
Fax Number	:	210-468-0682

Provider Business Practice Location Address
First Line	:	7433 LAS COLINAS BLVD STE 101
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75063-7577
Country	:	US
Telephone Number	:	800-404-6050
Fax Number	:	866-313-3397

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

Provider Enumeration Date	:	03/03/2012
Last Update Date	:	01/04/2023

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Directions to “ DONG SUK KIM D.C.” Practice Location

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