Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 6993 | NE |
NPI | 1003193152 |
---|---|
Provider Name | Bongok Kim |
First Address | Lincoln, NE 68583-0740 |
Second Address | Lincoln, NE 68583-0740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2011 |
Last Update Date | 03/11/2011 |