Provider Demographics
NPI:1003130550
Name:WOO S KIM CHIROPRACTIC REHAB THERAPY A PROF CORP
Entity Type:Organization
Organization Name:WOO S KIM CHIROPRACTIC REHAB THERAPY A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WOO
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:213-483-3987
Mailing Address - Street 1:2120 W 8TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4082
Mailing Address - Country:US
Mailing Address - Phone:213-483-3987
Mailing Address - Fax:213-483-5547
Practice Address - Street 1:2120 W 8TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4082
Practice Address - Country:US
Practice Address - Phone:213-483-3987
Practice Address - Fax:213-483-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27464AMedicare PIN