Provider Demographics
NPI:1053495770
Name:KIM, DAN HAKJAE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:HAKJAE
Last Name:KIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31371 RANCHO VIEJO RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1848
Mailing Address - Country:US
Mailing Address - Phone:949-240-6196
Mailing Address - Fax:949-240-9216
Practice Address - Street 1:31371 RANCHO VIEJO RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1848
Practice Address - Country:US
Practice Address - Phone:949-240-6196
Practice Address - Fax:949-240-9216
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor