Provider Demographics
NPI:1508152133
Name:KIM, STEPHEN Y (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:Y
Last Name:KIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:11326 CREEKSTONE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-6329
Mailing Address - Country:US
Mailing Address - Phone:858-717-6120
Mailing Address - Fax:858-565-4377
Practice Address - Street 1:7750 DAGGET ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2234
Practice Address - Country:US
Practice Address - Phone:858-717-6120
Practice Address - Fax:858-565-4377
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor