Provider Demographics
NPI:1013286038
Name:KIM, JOO YONG (DC)
Entity Type:Individual
Prefix:
First Name:JOO YONG
Middle Name:
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 1:6220 E LAKE SAMMAMISH PKWY SE
Mailing Address - Street 2:STE A
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-8925
Mailing Address - Country:US
Mailing Address - Phone:310-415-7248
Mailing Address - Fax:
Practice Address - Street 1:4959 PALO VERDE ST STE 100B
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2339
Practice Address - Country:US
Practice Address - Phone:909-626-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor