Provider Demographics
NPI:1336429398
Name:KIM, HYUNGSOO (DC)
Entity Type:Individual
Prefix:
First Name:HYUNGSOO
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 1:2970 W OLYMPIC BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2518
Mailing Address - Country:US
Mailing Address - Phone:213-388-4030
Mailing Address - Fax:213-388-4034
Practice Address - Street 1:2970 W OLYMPIC BLVD STE 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2518
Practice Address - Country:US
Practice Address - Phone:213-388-4030
Practice Address - Fax:213-388-4034
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor