Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DDS100080 | CA |
NPI | 1083072540 |
---|---|
Provider Name | Erica Tammy Kim |
First Address | Northridge, CA 91324-5968 |
Second Address | Northridge, CA 91324-5968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2016 |
Last Update Date | 26/12/2019 |