Provider Demographics
NPI:1699789479
Name:KIM, JOY HYUNAE (DC)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:HYUNAE
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 1:1401 S BROOKHURST RD
Mailing Address - Street 2:STE 103
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4471
Mailing Address - Country:US
Mailing Address - Phone:714-449-9700
Mailing Address - Fax:714-449-9992
Practice Address - Street 1:1401 S BROOKHURST RD
Practice Address - Street 2:STE 103
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4471
Practice Address - Country:US
Practice Address - Phone:714-449-9700
Practice Address - Fax:714-449-9992
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC25889Medicare ID - Type Unspecified