Provider Demographics
NPI:1568512085
Name:KIM, TAE KUN (DC)
Entity Type:Individual
Prefix:
First Name:TAE
Middle Name:KUN
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 1:3620 W PIONEER DR STE 109
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-1515
Mailing Address - Country:US
Mailing Address - Phone:972-790-6203
Mailing Address - Fax:972-790-6205
Practice Address - Street 1:3620 W PIONEER DR STE 109
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-1515
Practice Address - Country:US
Practice Address - Phone:972-790-6203
Practice Address - Fax:972-790-6205
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor