Individual
DONGYEON KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1780 OLD HIGHWAY 50 E, UNION, MO 63084-3219
(639) 695-6055
Mailing address
2290 DANIELS ST, MANTECA, CA 95337-6706
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DDS107522
CA
1223P0221X
Pediatric Dentistry
Primary
2023005564
MO
1223P0221X
Pediatric Dentistry
DDS107522
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/02/2018
Last updated
04/16/2023
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