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General NPI Number Information
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NPI Number | 1013120468
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Entity Type | Individual
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Provider Name | EUNICE Y IM DDS
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 715 S 1ST AVE SUITE D
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City | ARCADIA
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State | CA
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Zip | 91006-7525
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Country | US
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Telephone | 626-445-8600
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Fax | 626-445-8601
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Provider Business Mailing Address
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Address Line | 6161 TEMPLE CITY BLVD
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City | TEMPLE CITY
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State | CA
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Zip | 91780-1748
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Country | US
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Telephone | 626-445-8600
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Fax | 626-445-8601
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 47911
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License Number State | CA
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