Provider Demographics
NPI:1336340272
Name:DAN HAKJAE KIM, A PROFESSIONAL CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:DAN HAKJAE KIM, A PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-868-0100
Mailing Address - Street 1:12901 NORWALK BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3151
Mailing Address - Country:US
Mailing Address - Phone:562-686-0100
Mailing Address - Fax:
Practice Address - Street 1:12901 NORWALK BLVD STE 202
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3151
Practice Address - Country:US
Practice Address - Phone:562-686-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053495770OtherNPI TYPE 1#