Provider Demographics
NPI:1346275005
Name:KIM, ALBERT (DC)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
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 1:8345 W. THUNDEBIRD RD.
Mailing Address - Street 2:#B103
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3668
Mailing Address - Country:US
Mailing Address - Phone:623-334-4114
Mailing Address - Fax:623-334-4117
Practice Address - Street 1:8345 W. THUNDERBIRD RD.
Practice Address - Street 2:#B103
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-3668
Practice Address - Country:US
Practice Address - Phone:623-334-4114
Practice Address - Fax:623-334-4117
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104268Medicare ID - Type Unspecified