| NPI | 1053981407 |
|---|---|
| Professional Name | JAKE KIM |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 12660) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 13172) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2022-06-10 |