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General NPI Number Information
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NPI Number | 1629629134
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Entity Type | Organization
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Legal Business Name | ANSONY KIM, DDS INC
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 2591 MAIN ST
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City | OAKLEY
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State | CA
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Zip | 94561-1854
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Country | US
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Telephone | 925-690-5437
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Fax | 925-690-5438
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Provider Business Mailing Address
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Address Line | PO BOX 4604
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City | WALNUT CREEK
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State | CA
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Zip | 94596-0604
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Country | US
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Telephone | 510-334-3622
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANSONY JIN KIM
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Credential | DDS
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Telephone | 510-334-3622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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