Provider Demographics
NPI:1912286238
Name:DAN HAKJAE KIM, A PROFESSIONAL CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:DAN HAKJAE KIM, A PROFESSIONAL CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:HAKJAE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-240-6196
Mailing Address - Street 1:31105 RANCHO VIEJO RD
Mailing Address - Street 2:C9
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1717
Mailing Address - Country:US
Mailing Address - Phone:949-240-6196
Mailing Address - Fax:949-240-9216
Practice Address - Street 1:31105 RANCHO VIEJO RD
Practice Address - Street 2:C9
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1717
Practice Address - Country:US
Practice Address - Phone:949-240-6196
Practice Address - Fax:949-240-9216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty