Provider Demographics
NPI:1497028674
Name:KIM, MIN JUNG (DC)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:JUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 AYLESBURY DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5745
Mailing Address - Country:US
Mailing Address - Phone:469-258-6730
Mailing Address - Fax:972-769-7340
Practice Address - Street 1:907 AYLESBURY DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-5745
Practice Address - Country:US
Practice Address - Phone:469-258-6730
Practice Address - Fax:972-907-8502
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11731OtherTBCE