Provider Demographics
NPI:1225121882
Name:KIM, DIO D (DC, L AC)
Entity Type:Individual
Prefix:DR
First Name:DIO
Middle Name:D
Last Name:KIM
Suffix:
Gender:M
Credentials:DC, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14232 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3348
Mailing Address - Country:US
Mailing Address - Phone:714-505-5252
Mailing Address - Fax:714-505-1513
Practice Address - Street 1:14232 RED HILL AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-5836
Practice Address - Country:US
Practice Address - Phone:714-505-5252
Practice Address - Fax:714-505-1513
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27994111N00000X
CAAC10600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC10600OtherGENERAL INSURANCE
CADC27994OtherGENERAL INSURANCE