Provider Demographics
NPI:1265623532
Name:KIM, STEVE SEUNGTAE (DOCTOR OF CHIROPRACT)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:SEUNGTAE
Last Name:KIM
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:SEUNG TAE
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOCTOR OF CHIROPRACT
Mailing Address - Street 1:1950 E. CHAPMAN AVENUE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831
Mailing Address - Country:US
Mailing Address - Phone:714-525-5766
Mailing Address - Fax:714-525-5986
Practice Address - Street 1:1950 E. CHAPMAN AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831
Practice Address - Country:US
Practice Address - Phone:714-525-5766
Practice Address - Fax:714-525-5986
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 29934111N00000X
CADC29934111N00000X
CAAC11610171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29934Medicare UPIN