Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | EID19291008 | CA |
NPI | 1871964742 |
---|---|
Provider Name | Rachelle Kim |
First Address | Loma Linda, CA 92354-3055 |
Second Address | Loma Linda, CA 92354-3055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2015 |
Last Update Date | 16/10/2015 |