Provider Demographics
NPI:1528023272
Name:YOO, KIM Y (DC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:Y
Last Name:YOO
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 1:1135 W CHELTENHAM AVE
Mailing Address - Street 2:#1
Mailing Address - City:MELROSE PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3008
Mailing Address - Country:US
Mailing Address - Phone:215-782-3135
Mailing Address - Fax:215-782-3134
Practice Address - Street 1:1135 W CHELTENHAM AVE
Practice Address - Street 2:#1
Practice Address - City:MELROSE PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3008
Practice Address - Country:US
Practice Address - Phone:215-782-3135
Practice Address - Fax:215-782-3134
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA004765111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01267589Medicaid
PA01267589Medicaid