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General NPI Number Information
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NPI Number | 1578200804
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Entity Type | Organization
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Legal Business Name | JESSE G KIM DDS INC
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 5168 CUMBERLAND DR
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City | CYPRESS
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State | CA
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Zip | 90630-3618
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Country | US
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Telephone | 408-819-1709
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Fax |
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Provider Business Mailing Address
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Address Line | 5168 CUMBERLAND DR
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City | CYPRESS
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State | CA
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Zip | 90630-3618
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Country | US
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Telephone | 408-819-1709
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JESSE GAWSUNG KIM
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Credential | DDS
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Telephone | 408-819-1709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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