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General NPI Number Information
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NPI Number | 1356537070
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Entity Type | Organization
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Legal Business Name | WANGPICHIT AND KIM PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 09/17/2007
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Last Update Date | 09/17/2007
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Provider Practice Location Address
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Address Line | 11700 SOUTH ST SUITE 202
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City | ARTESIA
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State | CA
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Zip | 90701-6611
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Country | US
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Telephone | 562-924-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 11700 SOUTH ST SUITE 202
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City | ARTESIA
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State | CA
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Zip | 90701-6611
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Country | US
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Telephone | 562-924-5437
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. ILJOON KIM
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Credential | D.M.D.
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Telephone | 562-924-5437
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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 | 47921
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License Number State | CA
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