Provider Demographics
NPI:1053446955
Name:SDC CLINIC INC
Entity Type:Organization
Organization Name:SDC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-636-3681
Mailing Address - Street 1:9192 GARDEN GROVE BLVD
Mailing Address - Street 2:#A
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844
Mailing Address - Country:US
Mailing Address - Phone:714-636-3681
Mailing Address - Fax:714-636-3173
Practice Address - Street 1:9192 GARDEN GROVE BLVD
Practice Address - Street 2:#A
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844
Practice Address - Country:US
Practice Address - Phone:714-636-3681
Practice Address - Fax:714-636-3173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T82734Medicare UPIN