Individual provider Active NPI

David Jinsung Joo, D.C.

  • Chiropractor
  • San Diego, CA
National Provider Identifier
1770680928
Registry record updated Sep 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC30021 Issued in CA
Practice address
4655 Ruffner St Ste 120
San Diego, CA 92111-2226
Phone
(858) 292-0256
Fax
(858) 292-0459
NPI assigned
Sep 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC30021 CA Primary

Addresses

Primary practice location

4655 Ruffner St Ste 120
San Diego, CA 92111-2226

Mailing address

4655 Ruffner St Ste 120
San Diego, CA 92111-2226
Phone (858) 292-0256

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071128000385 CA Practitioner - Chiropractic 2860581840 Reassigns benefits to 1 organization
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC30021CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Joo Chiropractic Inc CurrentSince Mar 8, 2021 Accepting new patients

Locations

9855 Erma Rd
Ste 104
San Diego, CA 92131
Phone (858) 292-0256

4655 Ruffner St
Ste 120
San Diego, CA 92111
Phone (858) 292-0256

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599177600000",
    "number": "1770680928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4655 RUFFNER ST STE 120",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112226",
            "telephone_number": "858-292-0256",
            "fax_number": "858-292-0459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4655 RUFFNER ST STE 120",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112226",
            "telephone_number": "858-292-0256",
            "fax_number": "858-292-0459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOO",
        "first_name": "DAVID",
        "middle_name": "JINSUNG",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-09-04",
        "certification_date": "2020-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC30021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.