Provider Demographics
NPI:1427376672
Name:KIM, PHILLIP JUNG-WAN (DC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JUNG-WAN
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 1:3434 W 6TH ST STE 312
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-2578
Mailing Address - Country:US
Mailing Address - Phone:213-388-4556
Mailing Address - Fax:213-388-4557
Practice Address - Street 1:3434 W 6TH ST STE 312
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2578
Practice Address - Country:US
Practice Address - Phone:213-388-4556
Practice Address - Fax:213-388-4557
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor