Provider Demographics
NPI:1003071663
Name:KIM, SANG EON (DC, LAC)
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:EON
Last Name:KIM
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 E REMINGTON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1977
Mailing Address - Country:US
Mailing Address - Phone:408-720-8892
Mailing Address - Fax:408-720-8298
Practice Address - Street 1:693 E REMINGTON DR
Practice Address - Street 2:SUITE A
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1977
Practice Address - Country:US
Practice Address - Phone:408-720-8892
Practice Address - Fax:408-720-8298
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30142111N00000X
CAAC17256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist