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General NPI Number Information
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NPI Number | 1144439720
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Entity Type | Individual
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Provider Name | JEONG E. KIM DDS
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 450 S GLENDORA AVE STE. 106
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City | WEST COVINA
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State | CA
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Zip | 91790-3066
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Country | US
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Telephone | 626-856-3317
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Fax |
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Provider Business Mailing Address
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Address Line | 256 S LA FAYETTE PARK PL APT 207
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City | LOS ANGELES
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State | CA
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Zip | 90057-1385
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Country | US
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Telephone | 213-820-3398
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D54452
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License Number State | CA
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