Provider Demographics
NPI:1104097450
Name:KIM, HYUN JIP (DC)
Entity type:Individual
Prefix:
First Name:HYUN
Middle Name:JIP
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 1:3400 EL CAMINO REAL
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-2842
Mailing Address - Country:US
Mailing Address - Phone:408-261-2289
Mailing Address - Fax:408-261-2290
Practice Address - Street 1:3400 EL CAMINO REAL
Practice Address - Street 2:SUITE #1
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-2842
Practice Address - Country:US
Practice Address - Phone:408-261-2289
Practice Address - Fax:408-261-2290
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor