Provider Demographics
NPI:1184940009
Name:KIM, MICAH (DC)
Entity type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20657 GOLDEN SPRINGS DR
Mailing Address - Street 2:SUITE #202
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3875
Mailing Address - Country:US
Mailing Address - Phone:909-595-0011
Mailing Address - Fax:909-595-0212
Practice Address - Street 1:20657 GOLDEN SPRINGS DR
Practice Address - Street 2:SUITE #202
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91789-3875
Practice Address - Country:US
Practice Address - Phone:909-595-0011
Practice Address - Fax:909-595-0212
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor