Provider Demographics
NPI:1548289267
Name:KIM, KAP RYONG (DC, LAC)
Entity type:Individual
Prefix:
First Name:KAP
Middle Name:RYONG
Last Name:KIM
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC, LAC
Mailing Address - Street 1:650 S WESTLAKE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3885
Mailing Address - Country:US
Mailing Address - Phone:805-777-8154
Mailing Address - Fax:805-777-8157
Practice Address - Street 1:650 S WESTLAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3885
Practice Address - Country:US
Practice Address - Phone:805-777-8154
Practice Address - Fax:805-777-8157
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22741111N00000X
CAAC12636171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU59579Medicare UPIN
CABJ694Medicare PIN