Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 54192 | NY |
NPI | 1093966517 |
---|---|
Provider Name | Caroline Kim |
First Address | Bronx, NY 10467-2625 |
Second Address | Bronx, NY 10467-2625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2008 |
Last Update Date | 14/10/2008 |