Individual
GRACE JIAE KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1315 ANDERSON AVE, FORT LEE, NJ 07024-1769
(201) 886-8400
Mailing address
1315 ANDERSON AVE, FORT LEE, NJ 07024-1769
(201) 886-8400
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
059690
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
22DI02719500
NJ
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
32361
TX
Other
Enumeration date
06/04/2018
Last updated
11/29/2022
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