Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 46084 | CA |
NPI | 1053626556 |
---|---|
Provider Name | Dr. Soon No Kim |
First Address | Torrance, CA 90505-2863 |
Second Address | Torrance, CA 90505-2863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 10/08/2010 |