Provider Demographics
NPI:1891051736
Name:KIM, JENNY (DC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SHORELINE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-1400
Mailing Address - Country:US
Mailing Address - Phone:650-631-1500
Mailing Address - Fax:650-631-1504
Practice Address - Street 1:130 SHORELINE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94065-1400
Practice Address - Country:US
Practice Address - Phone:650-631-1500
Practice Address - Fax:650-631-1504
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32160OtherLICENSE