Provider Demographics
NPI:1740226075
Name:KIM, KYUNAM (DC)
Entity Type:Individual
Prefix:DR
First Name:KYUNAM
Middle Name:
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 1:1011 CONESTOGA RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1554
Mailing Address - Country:US
Mailing Address - Phone:610-772-1893
Mailing Address - Fax:484-453-8385
Practice Address - Street 1:525 W CHESTER PIKE STE 303
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4520
Practice Address - Country:US
Practice Address - Phone:484-453-8383
Practice Address - Fax:484-453-8385
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008004L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA095549UQVMedicare ID - Type Unspecified