Provider Demographics
NPI:1902257652
Name:KIM, JIN (DC)
Entity type:Individual
Prefix:
First Name:JIN
Middle Name:
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 1:2851 E MANOA RD
Mailing Address - Street 2:1-205
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1858
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2851 E MANOA RD
Practice Address - Street 2:1-205
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1858
Practice Address - Country:US
Practice Address - Phone:808-988-6113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor