Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1255886164 |
---|---|
Provider Name | Mrs. Hee Eun Kim |
First Address | Hillsboro, OR 97124-5802 |
Second Address | Hillsboro, OR 97124-5802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2016 |
Last Update Date | 20/08/2016 |