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General NPI Number Information
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NPI Number | 1740855618
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Entity Type | Individual
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Provider Name | SARAH EUNHA KIM
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Gender | Female
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Dates
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Enumeration Date | 05/24/2021
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 3211 COORS BLVD SW STE D2
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City | ALBUQUERQUE
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State | NM
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Zip | 87121-5255
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Country | US
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Telephone | 505-336-7418
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Fax |
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Provider Business Mailing Address
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Address Line | 8209 EDDY AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4978
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Country | US
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Telephone | 206-499-9412
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS108665
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DD5477
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License Number State | NM
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