Provider Demographics
NPI:1861677569
Name:KIM, JAE KU (DC)
Entity Type:Individual
Prefix:DR
First Name:JAE KU
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 1:2100 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4314
Mailing Address - Country:US
Mailing Address - Phone:718-677-3700
Mailing Address - Fax:718-677-1314
Practice Address - Street 1:2100 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4314
Practice Address - Country:US
Practice Address - Phone:718-677-3700
Practice Address - Fax:718-677-1314
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011451-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor