Provider Demographics
NPI:1730300146
Name:MIN, KEN KYUNG-JIN (DC)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:KYUNG-JIN
Last Name:MIN
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 1:430 S GARFIELD AVE STE 418
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3877
Mailing Address - Country:US
Mailing Address - Phone:606-570-8838
Mailing Address - Fax:626-570-8878
Practice Address - Street 1:430 S GARFIELD AVE STE 418
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3877
Practice Address - Country:US
Practice Address - Phone:606-570-8838
Practice Address - Fax:626-570-8878
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-27819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor