Individual
DR. ELLY BUNSUN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
4201 CENTRAL AVE NW, ALBUQUERQUE, NM 87105-1630
(505) 843-7172
Mailing address
4201 CENTRAL AVE NW, ALBUQUERQUE, NM 87105-1630
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3755
NM
Other
Enumeration date
08/24/2012
Last updated
08/24/2012
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