Provider Demographics
NPI:1922311489
Name:KIM, SEAN H (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:H
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 1:2535 KETTNER BLVD STE 2A3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-1253
Mailing Address - Country:US
Mailing Address - Phone:619-501-7873
Mailing Address - Fax:
Practice Address - Street 1:2535 KETTNER BLVD STE 2A3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1253
Practice Address - Country:US
Practice Address - Phone:619-501-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor