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General NPI Number Information
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NPI Number | 1780072165
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Entity Type | Organization
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Legal Business Name | NEW ROCHELLE KIDS DENTAL
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 77 QUAKER RIDGE RD SUITE 210
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City | NEW ROCHELLE
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State | NY
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Zip | 10804-2808
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Country | US
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Telephone | 914-632-2800
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Fax | 914-560-2075
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Provider Business Mailing Address
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Address Line | 77 QUAKER RIDGE RD SUITE 210
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City | NEW ROCHELLE
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State | NY
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Zip | 10804-2808
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Country | US
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Telephone | 914-632-2800
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Fax | 914-560-2075
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MOONSUN KIM
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Credential | DDS
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Telephone | 914-632-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 049857
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License Number State | NY
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