Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN20236 | MA |
NPI | 1366941338 |
---|---|
Provider Name | Frances Kim |
First Address | Jbsa Ft Sam Houston, TX 78234-0767 |
Second Address | San Antonio, TX 78234-2664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2018 |
Last Update Date | 06/02/2018 |