Provider Demographics
NPI:1962643189
Name:KIM, YONG J (DC)
Entity type:Individual
Prefix:DR
First Name:YONG
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1707 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2104
Mailing Address - Country:US
Mailing Address - Phone:916-483-6722
Mailing Address - Fax:916-488-0790
Practice Address - Street 1:1707 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2104
Practice Address - Country:US
Practice Address - Phone:916-483-6722
Practice Address - Fax:916-488-0790
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor