Provider Demographics
NPI:1255761367
Name:MYUNG SIM DANG CHIROPRACTIC INC
Entity type:Organization
Organization Name:MYUNG SIM DANG CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-809-2535
Mailing Address - Street 1:11867 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-4002
Mailing Address - Country:US
Mailing Address - Phone:562-809-2535
Mailing Address - Fax:562-809-7714
Practice Address - Street 1:11867 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-4002
Practice Address - Country:US
Practice Address - Phone:562-809-2535
Practice Address - Fax:562-809-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 24437305R00000X
CAAC 3608305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization