Provider Demographics
NPI:1073691689
Name:KIM, DAE HEE (DC)
Entity Type:Individual
Prefix:DR
First Name:DAE
Middle Name:HEE
Last Name:KIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:DAEHEE
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:3828 W COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2851
Mailing Address - Country:US
Mailing Address - Phone:714-773-9333
Mailing Address - Fax:714-773-9337
Practice Address - Street 1:3828 W COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2851
Practice Address - Country:US
Practice Address - Phone:714-773-9333
Practice Address - Fax:714-773-9337
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24722Medicare ID - Type Unspecified