Provider Demographics
NPI:1538285671
Name:KIM, PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
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 1:1145 E SAN ANTONIO DR STE A
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2379
Mailing Address - Country:US
Mailing Address - Phone:562-984-5505
Mailing Address - Fax:562-984-8599
Practice Address - Street 1:1145 E SAN ANTONIO DR STE A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2379
Practice Address - Country:US
Practice Address - Phone:562-984-5505
Practice Address - Fax:562-984-8599
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-28971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor