Provider Demographics
NPI:1376641332
Name:MAKOI, KIM (DC)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:MAKOI
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 1:601 VAN NESS AVE APT 52
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3263
Mailing Address - Country:US
Mailing Address - Phone:415-864-2975
Mailing Address - Fax:415-707-2011
Practice Address - Street 1:459 FULTON ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4364
Practice Address - Country:US
Practice Address - Phone:415-864-2975
Practice Address - Fax:415-707-2011
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0255490Medicaid
CADC0255490Medicaid