Provider Demographics
NPI:1245394600
Name:KIM, CYNTHIA JEEYON (DC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JEEYON
Last Name:KIM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JEEYON
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:615 S MAIN STREET STE 1
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035
Mailing Address - Country:US
Mailing Address - Phone:408-945-7717
Mailing Address - Fax:408-946-8145
Practice Address - Street 1:615 S MAIN STREET STE 1
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035
Practice Address - Country:US
Practice Address - Phone:408-945-7717
Practice Address - Fax:408-946-8145
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0285030OtherPPIN
CADC28503OtherLICENSE
CAU99000Medicare UPIN
CADC28503OtherLICENSE