Provider Demographics
NPI:1871777417
Name:KIM, KARIN (DC)
Entity type:Individual
Prefix:MRS
First Name:KARIN
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 1:3620 LONG BEACH BLVD
Mailing Address - Street 2:C-11
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4022
Mailing Address - Country:US
Mailing Address - Phone:562-997-0966
Mailing Address - Fax:562-981-6637
Practice Address - Street 1:1225 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-997-0966
Practice Address - Fax:562-981-6637
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA510514037OtherTAX IDENTIFICATION NUMBER