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Individual
JAE EUN KIM
Active
Individual
JAE EUN KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
104068
CA
1223G0001X
General Practice Dentistry
Primary
104068
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104068
AVAILITY
CA
05
—
104068
—
CA
Enumeration date
07/19/2019
Last updated
04/13/2023
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