| NPI | 1003388307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES YOUNG KIM Authorized Official 760-779-5662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2022-08-11 |