Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 062060-01 | NY |
NPI | 1093370801 |
---|---|
Provider Name | Sangmee Kim |
First Address | Malta, NY 12020-5223 |
Second Address | Clifton Park, NY 12065-1302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2019 |
Last Update Date | 30/09/2021 |