Provider Demographics
NPI:1689771917
Name:KIM, SUNG S (DC)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:SUNG
Other - Middle Name:JAMES
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:615 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-8521
Mailing Address - Country:US
Mailing Address - Phone:408-945-7717
Mailing Address - Fax:408-946-8145
Practice Address - Street 1:615 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-8521
Practice Address - Country:US
Practice Address - Phone:408-945-7717
Practice Address - Fax:408-946-8145
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0288050OtherPPIN
CADC28805OtherLICENSE
CAU98999Medicare UPIN
CAZZZ28600ZMedicare ID - Type UnspecifiedGROUP ID