| Ssung J. Kimmi Pc | |
|
12795 Sw 3rd St Beaverton OR 97005-2704 | |
| (503) 641-4244 | |
| (503) 641-0551 |
| Full Name | Ssung J. Kimmi Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 12795 Sw 3rd St, Beaverton, Oregon |
| Authorized Official Name and Position | Ssung J Kimmi (PRESIDENT) |
| Authorized Official Contact | 5036414244 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ssung J. Kimmi Pc 12795 Sw 3rd Street Beaverton OR 97005 Ph: (503) 641-4244 | Ssung J. Kimmi Pc 12795 Sw 3rd St Beaverton OR 97005-2704 Ph: (503) 641-4244 |
| NPI Number | 1568768992 |
|---|---|
| Provider Enumeration Date | 02/02/2011 |
| Last Update Date | 01/27/2014 |
| Medicare PECOS PAC ID | 1658553219 |
|---|---|
| Medicare Enrollment ID | O20110303000585 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568768992 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 3444 (Oregon) | Primary |
| Provider Name | Ssung J Kimmi |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1912026196 PECOS PAC ID: 1153224159 Enrollment ID: I20040128000655 |
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