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General NPI Number Information
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NPI Number | 1144603275
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Entity Type | Individual
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Provider Name | SAI MI KIM
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Gender | Female
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/04/2018
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Provider Practice Location Address
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Address Line | 713 FOXON RD
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City | EAST HAVEN
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State | CT
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Zip | 06513
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Country | US
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Telephone | 203-466-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 456 PARK ST
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City | HARTFORD
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State | CT
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Zip | 06106-1525
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11432
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License Number State | CT
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