Provider Demographics
NPI:1619290475
Name:KIM, KOICHI SUZUKI (DC)
Entity Type:Individual
Prefix:
First Name:KOICHI
Middle Name:SUZUKI
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 1:2503 EASTBLUFF DR
Mailing Address - Street 2:103
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3505
Mailing Address - Country:US
Mailing Address - Phone:949-640-5700
Mailing Address - Fax:949-640-5700
Practice Address - Street 1:2503 EASTBLUFF DR
Practice Address - Street 2:103
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3549
Practice Address - Country:US
Practice Address - Phone:949-640-5700
Practice Address - Fax:949-640-5700
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor