Provider Demographics
NPI:1699864728
Name:KIM, JIN-YOUNG (DC)
Entity type:Individual
Prefix:DR
First Name:JIN-YOUNG
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 1:14608 HIGHWAY 99 STE 309
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-5500
Mailing Address - Country:US
Mailing Address - Phone:206-650-6524
Mailing Address - Fax:
Practice Address - Street 1:1032 S JACKSON ST STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3038
Practice Address - Country:US
Practice Address - Phone:206-650-6524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8393738Medicaid
WAU97897Medicare UPIN
WA8857192Medicare ID - Type Unspecified