1376837559 NPI number — MR. JOHN TAE-KWON KIM M.S., L.AC.

Table of content: MR. JOHN TAE-KWON KIM M.S., L.AC. (NPI 1376837559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376837559 NPI number — MR. JOHN TAE-KWON KIM M.S., L.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
JOHN
Provider Middle Name:
TAE-KWON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S., L.AC.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376837559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 N JOSEY LN
Provider Second Line Business Mailing Address:
# 717
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75010-4616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-415-1876
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 TROPHY LAKE DR
Provider Second Line Business Practice Location Address:
SUITE 322
Provider Business Practice Location Address City Name:
TROPHY CLUB
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76262-5222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-643-9940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC01261 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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