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NPI Code Detail

MEDICARE: GRACE KIM

MEDICARE: GRACE KIM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0221XPediatric DentistryDDS107335CA

General Provider Information

NPI Number : 1710448766
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE KIM
Provider Business Mailing Address
First Line : 12626 CROSSDALE AVE
Second Line :
City : NORWALK
State : CA
Zip : 90650-2671
Country : US
Telephone Number : 562-565-7021
Fax Number :
Provider Business Practice Location Address
First Line : 29950 HAUN RD STE 302
Second Line :
City : MENIFEE
State : CA
Zip : 92586-6527
Country : US
Telephone Number : 951-679-1667
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2019
Last Update Date : 06/23/2022

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Directions to “ GRACE KIM ” Practice Location

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