Provider Demographics
NPI:1356560627
Name:KIM, NAMJIN AUSTIN (DC)
Entity type:Individual
Prefix:MR
First Name:NAMJIN
Middle Name:AUSTIN
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 1:18002 WIKA RD
Mailing Address - Street 2:# A
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2125
Mailing Address - Country:US
Mailing Address - Phone:760-242-4579
Mailing Address - Fax:760-242-4762
Practice Address - Street 1:18002 WIKA RD
Practice Address - Street 2:# A
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2125
Practice Address - Country:US
Practice Address - Phone:760-242-4579
Practice Address - Fax:760-242-4762
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0295500Medicare PIN