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General NPI Number Information
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NPI Number | 1528802840
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Entity Type | Individual
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Provider Name | GINA YEAWON KIM DDS
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Gender | Female
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Dates
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Enumeration Date | 06/21/2024
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 6859 MAGNOLIA AVE STE 2
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City | RIVERSIDE
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State | CA
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Zip | 92506-2866
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Country | US
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Telephone | 951-682-0810
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Fax | 951-289-9552
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Provider Business Mailing Address
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Address Line | 6859 MAGNOLIA AVE STE 2
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City | RIVERSIDE
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State | CA
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Zip | 92506-2866
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Country | US
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Telephone | 951-682-0810
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Fax | 951-289-9552
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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 | 110180
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License Number State | CA
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