Individual
JUAN KIM
Active
Individual
JUAN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D10311
OR
1223G0001X
General Practice Dentistry
2018011706
MO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2018011706
MO
Other
Enumeration date
08/18/2015
Last updated
12/10/2024
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