Provider Demographics
NPI:1013725712
Name:KIM, MIN JAE (DC)
Entity type:Individual
Prefix:DR
First Name:MIN JAE
Middle Name:
Last Name:KIM
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 S BEACH BLVD APT L1114
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-1187
Mailing Address - Country:US
Mailing Address - Phone:213-500-7124
Mailing Address - Fax:
Practice Address - Street 1:2720 N HARBOR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2625
Practice Address - Country:US
Practice Address - Phone:213-500-7124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor