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General NPI Number Information
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NPI Number | 1710466248
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Entity Type | Individual
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Provider Name | DR. SUE VIN KIM
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Gender | Female
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 1308 ORCHARD AVE
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City | LOS ANGELES
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State | CA
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Zip | 90006-4712
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Country | US
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Telephone | 844-757-9799
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Fax |
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Provider Business Mailing Address
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Address Line | 2217 MONTROSE AVE UNIT 7
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City | MONTROSE
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State | CA
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Zip | 91020-1549
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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 | 103027
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License Number State | CA
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