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General NPI Number Information
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NPI Number | 1467123331
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Entity Type | Individual
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Provider Name | CHAE JIN KIM DDS
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Gender | Female
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 3760 W MCFADDEN AVE STE D
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City | SANTA ANA
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State | CA
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Zip | 92704-1392
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Country | US
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Telephone | 657-231-6106
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Fax |
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Provider Business Mailing Address
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Address Line | 16570 FERN HAVEN RD
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745-3708
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Country | US
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Telephone | 949-677-1348
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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 | 106984
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License Number State | CA
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