Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 62248 | CA |
NPI | 1669810347 |
---|---|
Provider Name | Mrs. Unyong Kim |
First Address | Gold River, CA 95670-7528 |
Second Address | Gold River, CA 95670-7528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2013 |
Last Update Date | 04/06/2013 |