| NPI | 1821574864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IL SEON KIM Owner 626-964-1884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 33302) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics |
| 1223G0001X Dentist, General Practice | |
| 1223P0221X Dentist, Pediatric Dentistry | |
| 1223P0300X Dentist, Periodontics | |
| 1223X0008X Dentist, Oral and Maxillofacial Radiology | |
| 1223P0700X Dentist, Prosthodontics | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery | |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2018-07-12 |