Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 055236 | NY |
NPI | 1033426390 |
---|---|
Provider Name | Dr. Jennifer Hyunjung Kim |
First Address | Stamford, CT 06901-1871 |
Second Address | Hartsdale, NY 10530-1564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2010 |
Last Update Date | 19/09/2016 |