| NPI | 1730563107 |
|---|---|
| Former Name | JEAN KIM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NJ 22DI02794500) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NY 060486) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS042263) | |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2025-06-11 |