Provider Demographics
NPI:1821397746
Name:KIM, TAE YONG (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:TAE YONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12505 BEL RED RD
Mailing Address - Street 2:#112
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2510
Mailing Address - Country:US
Mailing Address - Phone:425-484-9230
Mailing Address - Fax:206-309-9063
Practice Address - Street 1:819 SOUTH 3RD STREET
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057
Practice Address - Country:US
Practice Address - Phone:425-687-2707
Practice Address - Fax:206-309-9063
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60183187111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor