Provider Demographics
NPI:1417064114
Name:KIM, CHRIS HYON (D,O,)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:HYON
Last Name:KIM
Suffix:
Gender:M
Credentials:D,O,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9420 RESEDA BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-6026
Mailing Address - Country:US
Mailing Address - Phone:818-772-0948
Mailing Address - Fax:818-772-0478
Practice Address - Street 1:9420 RESEDA BLVD STE 6
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-6026
Practice Address - Country:US
Practice Address - Phone:818-772-0948
Practice Address - Fax:818-772-0478
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV03332Medicare UPIN
CADC29553Medicare ID - Type UnspecifiedLICENSE