Provider Demographics
NPI:1447269576
Name:KIM, YOUNG HWAN (DC)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:HWAN
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 1:8917 S OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9146
Mailing Address - Country:US
Mailing Address - Phone:614-286-3331
Mailing Address - Fax:
Practice Address - Street 1:8917 S OLD STATE RD
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9146
Practice Address - Country:US
Practice Address - Phone:614-726-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2598925Medicaid
OHU92214Medicare UPIN
OH2598925Medicaid