Provider Demographics
NPI:1154491728
Name:KIM, SEUNGWEON (DC)
Entity Type:Individual
Prefix:
First Name:SEUNGWEON
Middle Name:
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 1:1837 NORRISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2837
Mailing Address - Country:US
Mailing Address - Phone:215-614-9808
Mailing Address - Fax:215-641-9809
Practice Address - Street 1:1837 NORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:MAPLE GLEN
Practice Address - State:PA
Practice Address - Zip Code:19002-2837
Practice Address - Country:US
Practice Address - Phone:215-614-9808
Practice Address - Fax:215-641-9809
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007462L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU92362Medicare UPIN
PA063604Medicare ID - Type Unspecified