Provider Demographics
NPI:1942727409
Name:KIM, BERNARD (DC, BSC)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DC, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 OLD NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4135
Mailing Address - Country:US
Mailing Address - Phone:408-627-9509
Mailing Address - Fax:
Practice Address - Street 1:1431 WARNER AVE STE D
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6444
Practice Address - Country:US
Practice Address - Phone:714-258-7116
Practice Address - Fax:714-258-8474
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33963111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation