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General NPI Number Information
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NPI Number | 1659832780
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Entity Type | Individual
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Provider Name | JAMIE KIM DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 2483 SUNRISE BLVD
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City | GOLD RIVER
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State | CA
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Zip | 95670-4344
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Country | US
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Telephone | 678-373-2536
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Fax |
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Provider Business Mailing Address
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Address Line | 2483 SUNRISE BLVD
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City | GOLD RIVER
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State | CA
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Zip | 95670-4344
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Country | US
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Telephone | 678-373-2536
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 103281
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License Number State | CA
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