Provider Demographics
NPI:1871904045
Name:KIM, JASON (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
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 1:11900 NE 1ST ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3046
Mailing Address - Country:US
Mailing Address - Phone:425-283-3023
Mailing Address - Fax:
Practice Address - Street 1:11900 NE 1ST ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3046
Practice Address - Country:US
Practice Address - Phone:425-283-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60439749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACH60439749OtherCHIROPRACTIC LICENSE NUMBER