Active NPI
Tae Kyung Kim, DC
- Chiropractor
- Moreno Valley, CA
National Provider Identifier
1629533666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC28107
- Practice address
- 11441 Heacock St Ste E
Moreno Valley, CA 92557-7907 - Phone
- (951) 567-1476
- NPI assigned
- Feb 4, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC28107 | CA | Primary |
Addresses
Primary practice location
11441 Heacock St Ste E
Moreno Valley, CA 92557-7907
Mailing address
11441 Heacock St Ste E
Moreno Valley, CA 92557-7907
Phone (951) 567-1476
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC28107 | CA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549238400000",
"number": "1629533666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11441 HEACOCK ST STE E",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925577907",
"telephone_number": "951-567-1476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11441 HEACOCK ST STE E",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925577907",
"telephone_number": "951-567-1476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "TAE KYUNG",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-04",
"last_updated": "2019-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC28107",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.