Provider Demographics
NPI:1316282544
Name:KIM, JOHN J (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
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 1:2070 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5233
Mailing Address - Country:US
Mailing Address - Phone:808-959-4588
Mailing Address - Fax:808-959-4580
Practice Address - Street 1:2070 KILAUEA AVE
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5233
Practice Address - Country:US
Practice Address - Phone:808-959-4588
Practice Address - Fax:808-959-4580
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012301111N00000X
HIDC-1273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI428950001Medicare PIN
IL428950001Medicare PIN