Individual
GRACE KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5155 KATELLA AVE APT 309, CYPRESS, CA 90720-2957
(860) 405-5915
Mailing address
5155 KATELLA AVE APT 309, CYPRESS, CA 90720-2957
(860) 405-5915
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DDS109657
CA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/09/2022
Last updated
07/31/2025
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