Provider Demographics
NPI:1558734921
Name:EUN KIM CHIROPRACTIC INC
Entity Type:Organization
Organization Name:EUN KIM CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EUN
Authorized Official - Middle Name:CHA
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:714-494-9355
Mailing Address - Street 1:13240 ABANA PLACE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703
Mailing Address - Country:US
Mailing Address - Phone:714-494-9355
Mailing Address - Fax:
Practice Address - Street 1:411 ATLAS STREET
Practice Address - Street 2:SUITE A
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-494-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-07
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
CA16209171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty