Provider Demographics
NPI:1164773800
Name:KIM, JONG H (DC, CCEP)
Entity Type:Individual
Prefix:DR
First Name:JONG
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:DC, CCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22638 MEYLER ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2347
Mailing Address - Country:US
Mailing Address - Phone:213-447-3234
Mailing Address - Fax:424-202-5486
Practice Address - Street 1:2583 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-7035
Practice Address - Country:US
Practice Address - Phone:213-447-3234
Practice Address - Fax:424-202-5486
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32403111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation