Provider Demographics
NPI:1366896045
Name:KIM, YOUNG JIN (DC)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:JIN
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 1:990 GRAND CANYON PKWY
Mailing Address - Street 2:SUITE 114
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1739
Mailing Address - Country:US
Mailing Address - Phone:847-648-4101
Mailing Address - Fax:847-744-5128
Practice Address - Street 1:990 GRAND CANYON PKWY
Practice Address - Street 2:SUITE 114
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1739
Practice Address - Country:US
Practice Address - Phone:847-648-4101
Practice Address - Fax:847-744-5128
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty