Provider Demographics
NPI:1780933150
Name:KIM, WON SEOK (DC)
Entity type:Individual
Prefix:DR
First Name:WON SEOK
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 1:5675 RISING SUN AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2100
Mailing Address - Country:US
Mailing Address - Phone:267-343-4930
Mailing Address - Fax:267-343-8051
Practice Address - Street 1:5675 RISING SUN AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-2100
Practice Address - Country:US
Practice Address - Phone:267-343-4930
Practice Address - Fax:267-343-8051
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010932111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor