Provider Demographics
NPI:1376987149
Name:KIM, HAN JIN (DC, LAC)
Entity Type:Individual
Prefix:
First Name:HAN JIN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 PECK RD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-1309
Mailing Address - Country:US
Mailing Address - Phone:626-226-3712
Mailing Address - Fax:626-582-8664
Practice Address - Street 1:4703 PECK RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-1309
Practice Address - Country:US
Practice Address - Phone:626-226-3712
Practice Address - Fax:626-582-8664
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31873111N00000X
CA14083171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist