| NPI | 1871121707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIN YOUNG KIM CEO 909-859-8800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2020-03-27 |