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General NPI Number Information
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NPI Number | 1689016255
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Entity Type | Individual
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Provider Name | AILEEN KIM D.D.S., M.S.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2013
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Last Update Date | 03/05/2014
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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 | 626-483-7714
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 S GRAND AVE APT 706
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City | LOS ANGELES
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State | CA
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Zip | 90015-2169
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Country | US
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Telephone |
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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 | 61307
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License Number State | CA
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