Provider Demographics
NPI:1811161482
Name:SIM, YOUNG DONG (DC)
Entity type:Individual
Prefix:
First Name:YOUNG DONG
Middle Name:
Last Name:SIM
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 1:2216 ROYAL LN
Mailing Address - Street 2:SUITE 113
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-7802
Mailing Address - Country:US
Mailing Address - Phone:469-231-6152
Mailing Address - Fax:972-243-2206
Practice Address - Street 1:2216 ROYAL LN
Practice Address - Street 2:SUITE 113
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-7802
Practice Address - Country:US
Practice Address - Phone:469-231-6152
Practice Address - Fax:972-243-2206
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor