NPI | 1942615364 |
---|---|
Former Name | STEPHANIE KIM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12014639A) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
1223G0001X Dentist, General Practice (Licence: CA 64762) | |
1223P0221X Dentist, Pediatric Dentistry (Licence: CA 64762) | |
Enumeration Date | 2014-06-24 |
Last Update Date | 2025-01-22 |