Provider Demographics
NPI:1902220619
Name:RICHARD KIM CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:RICHARD KIM CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANG
Authorized Official - Middle Name:SUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-493-8387
Mailing Address - Street 1:2391 BELL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2019
Mailing Address - Country:US
Mailing Address - Phone:718-224-8382
Mailing Address - Fax:718-224-2488
Practice Address - Street 1:2391 BELL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2019
Practice Address - Country:US
Practice Address - Phone:718-224-8382
Practice Address - Fax:718-224-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty