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General NPI Number Information
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NPI Number | 1144026733
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Entity Type | Organization
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Legal Business Name | AMY KIM DMD INC.
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 14252 SCHLEISMAN RD STE 102
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City | EASTVALE
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State | CA
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Zip | 92880-4026
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Country | US
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Telephone | 951-507-1073
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Fax | 951-507-1332
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Provider Business Mailing Address
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Address Line | 14252 SCHLEISMAN RD STE 102
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City | EASTVALE
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State | CA
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Zip | 92880-4026
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Country | US
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Telephone | 951-507-1073
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Fax | 951-507-1332
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. AMY KIM
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Credential | DMD
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Telephone | 909-270-6602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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