Provider Demographics
NPI:1396863148
Name:KIM, TAI YUN (DC)
Entity Type:Individual
Prefix:DR
First Name:TAI
Middle Name:YUN
Last Name:KIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TAYLOR
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1265 MONTECITO AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-4581
Mailing Address - Country:US
Mailing Address - Phone:650-938-5151
Mailing Address - Fax:650-938-5153
Practice Address - Street 1:1265 MONTECITO AVE STE 103
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-4581
Practice Address - Country:US
Practice Address - Phone:650-938-5151
Practice Address - Fax:650-938-5153
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor