Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 57449 | CA |
NPI | 1154578144 |
---|---|
Provider Name | Dr. Ina Kim |
First Address | Foster City, CA 94404-1724 |
Second Address | San Leandro, CA 94577-4465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2008 |
Last Update Date | 19/11/2012 |