Provider Demographics
NPI:1568768992
Name:SSUNG J. KIMMI PC
Entity Type:Organization
Organization Name:SSUNG J. KIMMI PC
Other - Org Name:BEST CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SSUNG
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIMMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-641-4244
Mailing Address - Street 1:12795 SW 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005
Mailing Address - Country:US
Mailing Address - Phone:503-641-4244
Mailing Address - Fax:503-641-0551
Practice Address - Street 1:12795 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2704
Practice Address - Country:US
Practice Address - Phone:503-641-4244
Practice Address - Fax:503-641-0551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3444261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR117228Medicare PIN
ORR158286Medicare PIN