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General NPI Number Information
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NPI Number | 1679985477
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Entity Type | Organization
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Legal Business Name | AILEEN SEHEE KIM DENTAL CORPORATION
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Dates
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Enumeration Date | 05/28/2014
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Last Update Date | 05/28/2014
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Provider Practice Location Address
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Address Line | 933 S SUNSET AVE #208
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City | WEST COVINA
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State | CA
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Zip | 91790-3410
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Country | US
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Telephone | 626-600-6080
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Fax | 626-800-1245
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Provider Business Mailing Address
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Address Line | 933 S SUNSET AVE #208
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City | WEST COVINA
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State | CA
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Zip | 91790-3410
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Country | US
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Telephone | 626-600-6080
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Fax | 626-800-1245
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Authorized Official
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Title or Position | PRESIDENT
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Name | AILEEN KIM
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Credential | DDS, MS
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Telephone | 626-600-6080
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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 | 61307
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License Number State | CA
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