Provider Demographics
NPI:1437124104
Name:KIM, SANG H (DC)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:H
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 1:704 DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1214
Mailing Address - Country:US
Mailing Address - Phone:610-313-3185
Mailing Address - Fax:610-313-3187
Practice Address - Street 1:704 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1214
Practice Address - Country:US
Practice Address - Phone:610-313-3185
Practice Address - Fax:610-313-3187
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006298L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7827654OtherAETNA
PA008539Medicare ID - Type Unspecified