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General NPI Number Information
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NPI Number | 1194379180
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Entity Type | Individual
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Provider Name | CHAI YOON KIM DDS, MSD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2019
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 320 SYCAMORE AVE STE 60
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City | VISTA
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State | CA
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Zip | 92083-7797
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Country | US
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Telephone | 919-601-0564
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Fax |
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Provider Business Mailing Address
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Address Line | 50 MALDEN ST APT 106
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City | BOSTON
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State | MA
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Zip | 02118-2888
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | RESIDENT
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DDS107440
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License Number State | CA
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