Provider Demographics
NPI:1285037689
Name:AN, KYUNGHWAN (DC)
Entity Type:Individual
Prefix:DR
First Name:KYUNGHWAN
Middle Name:
Last Name:AN
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 1:12121 BLUE RIDGE EXT STE A
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1103
Mailing Address - Country:US
Mailing Address - Phone:816-217-0020
Mailing Address - Fax:816-469-5325
Practice Address - Street 1:12121 BLUE RIDGE BLVD
Practice Address - Street 2:SUITE O
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1723
Practice Address - Country:US
Practice Address - Phone:816-217-0020
Practice Address - Fax:816-469-5325
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013013772111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist