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General NPI Number Information
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NPI Number | 1861896862
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Entity Type | Organization
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Legal Business Name | NORTHAMPTON FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 69 BRIDGE ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-2402
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Country | US
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Telephone | 413-584-1722
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Fax | 413-584-5835
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Provider Business Mailing Address
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Address Line | 69 BRIDGE ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-2402
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Country | US
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Telephone | 413-584-1722
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Fax | 413-584-5835
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHULHWAN JAKE KIM
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Credential | D.M.D.
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Telephone | 617-869-0000
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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 | DN22064
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License Number State | MA
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