Provider Demographics
NPI:1457543910
Name:KIM, GREG S (DC)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:S
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 1:12951 NE BEL RED RD. STE 120
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2628
Mailing Address - Country:US
Mailing Address - Phone:425-679-9255
Mailing Address - Fax:425-455-2910
Practice Address - Street 1:12951 NE BEL RED RD. STE 120
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2628
Practice Address - Country:US
Practice Address - Phone:425-679-9255
Practice Address - Fax:425-455-2910
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV08808Medicare UPIN