Individual
JI WON KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
555 STATE ST, SPRINGFIELD, MA 01109-4140
(312) 768-0965
Mailing address
350 N CLARK ST STE 600, CHICAGO, IL 60654-4782
(312) 274-4580
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN1859098
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
04/27/2021
Last updated
07/21/2021
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