Provider Demographics
NPI:1023204021
Name:KIM, YONG HYEON (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:YONG HYEON
Middle Name:
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 1:355 GELLERT BLVD
Mailing Address - Street 2:#105
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2665
Mailing Address - Country:US
Mailing Address - Phone:415-671-5255
Mailing Address - Fax:888-772-8429
Practice Address - Street 1:355 GELLERT BLVD
Practice Address - Street 2:#105
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2665
Practice Address - Country:US
Practice Address - Phone:415-671-5255
Practice Address - Fax:888-772-8429
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29972111N00000X
CA6373171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist