| NPI | 1972568020 |
|---|---|
| Former Name | CHONG WON KIM |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 22551) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 37652) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2021-03-03 |