Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 47911 | CA |
NPI | 1013120468 |
---|---|
Provider Name | Mrs. Eunice Y Im |
First Address | Temple City, CA 91780-1748 |
Second Address | Arcadia, CA 91006-7525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 14/12/2012 |