Provider Demographics
NPI:1720559396
Name:SOO JIN KIM CHIROPRACTIC INC
Entity Type:Organization
Organization Name:SOO JIN KIM CHIROPRACTIC INC
Other - Org Name:PRIMO CHIROPRACTIC & ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SOO JIN
Authorized Official - Middle Name:JIN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:323-203-4414
Mailing Address - Street 1:819 S ALVARADO ST STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4085
Mailing Address - Country:US
Mailing Address - Phone:323-203-4414
Mailing Address - Fax:213-352-4069
Practice Address - Street 1:25000 AVENUE STANFORD STE 174
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4596
Practice Address - Country:US
Practice Address - Phone:323-203-4414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty