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General NPI Number Information
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NPI Number | 1376279430
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Entity Type | Organization
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Legal Business Name | KIM ORTHODONTICS
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 07/29/2022
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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 | 2850 EL CERRO CT APT 317
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City | CARLSBAD
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State | CA
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Zip | 92010-6715
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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 | ORTHODONTIST
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Name | DR. CHAI YOON KIM
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Credential | DDS, MSD
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Telephone | 919-601-0564
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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 |
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License Number State |
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