Provider Demographics
NPI:1851652382
Name:KIM, DANIEL JIYONG (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JIYONG
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 1:1354 THE ALAMEDA
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-5000
Mailing Address - Country:US
Mailing Address - Phone:408-899-2288
Mailing Address - Fax:
Practice Address - Street 1:1354 THE ALAMEDA
Practice Address - Street 2:SUITE 11
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-5000
Practice Address - Country:US
Practice Address - Phone:408-899-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31865111NS0005X
CACA-DC31865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor