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General NPI Number Information
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NPI Number | 1467135574
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Entity Type | Individual
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Provider Name | JI WON KIM
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Gender | Female
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 2361 BRISTOL RD
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City | BENSALEM
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State | PA
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Zip | 19020-6000
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Country | US
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Telephone | 215-752-4514
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Fax | 215-752-5551
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Provider Business Mailing Address
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Address Line | 2361 BRISTOL RD
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City | BENSALEM
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State | PA
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Zip | 19020-6000
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Country | US
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Telephone | 215-752-4514
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Fax | 215-752-5551
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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 | DS045637
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License Number State | PA
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