Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 7223 | KS |
NPI | 1003230665 |
---|---|
Provider Name | Joon Won Kim |
First Address | Overland Park, KS 66211-1318 |
Second Address | Overland Park, KS 66211-1318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2014 |
Last Update Date | 18/02/2014 |