Provider Demographics
NPI:1942491352
Name:KIM, MIKAEL WOO (DC)
Entity Type:Individual
Prefix:
First Name:MIKAEL
Middle Name:WOO
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 1:2472 PLEASANT HILL RD
Mailing Address - Street 2:203A
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1746
Mailing Address - Country:US
Mailing Address - Phone:770-623-9229
Mailing Address - Fax:
Practice Address - Street 1:2472 PLEASANT HILL RD
Practice Address - Street 2:203A
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1746
Practice Address - Country:US
Practice Address - Phone:770-623-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29501111N00000X
GACHIR009239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor