Healthcare Provider Details

I. General information

NPI: 1760613913
Provider Name (Legal Business Name): SAEHEE KIM D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 09/07/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 WESTWOOD DR STE D
SAN JOSE CA
95125-5105
US

IV. Provider business mailing address

1680 WESTWOOD DR STE D
SAN JOSE CA
95125-5105
US

V. Phone/Fax

Practice location:
  • Phone: 212-874-3929
  • Fax:
Mailing address:
  • Phone: 425-263-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number60847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: