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General NPI Number Information
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NPI Number | 1639756224
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Entity Type | Individual
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Provider Name | THERESA KIM DMD
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Gender | Female
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Dates
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Enumeration Date | 03/28/2021
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 339 E LELAND RD
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City | PITTSBURG
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State | CA
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Zip | 94565-4911
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Country | US
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Telephone | 925-363-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 638 55TH ST
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City | OAKLAND
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State | CA
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Zip | 94609-1602
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Country | US
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Telephone | 503-997-3968
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 108165
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License Number State | CA
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