Provider Demographics
NPI:1053406520
Name:KIM, KYU BOOM (DC)
Entity type:Individual
Prefix:
First Name:KYU
Middle Name:BOOM
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 1:11813 E. DEL AMO BLVD.
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7605
Mailing Address - Country:US
Mailing Address - Phone:562-468-0023
Mailing Address - Fax:562-468-0025
Practice Address - Street 1:11813 E. DEL AMO BLVD.
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7605
Practice Address - Country:US
Practice Address - Phone:562-468-0023
Practice Address - Fax:562-468-0025
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor