Provider Demographics
NPI:1104896216
Name:KIM, MEE KYUNG (DC)
Entity type:Individual
Prefix:
First Name:MEE KYUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 PLEASANT VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1222
Mailing Address - Country:US
Mailing Address - Phone:215-500-2000
Mailing Address - Fax:215-500-2000
Practice Address - Street 1:7320 OLD YORK RD STE 207A
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3007
Practice Address - Country:US
Practice Address - Phone:215-500-2000
Practice Address - Fax:888-778-8180
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00173100171100000X
NJ38MC00631100111N00000X
PADC009262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ38MC00631100OtherDC LICENSE
PADC009262OtherDC LICENSE
NJ25MZ00173100OtherLAC