Individual
JASON MINJE KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2100 MILLER PARK WAY, WEST MILWAUKEE, WI 53219-1641
(317) 965-9259
Mailing address
161 W WISCONSIN AVE APT 214, MILWAUKEE, WI 53203-2605
(317) 965-9259
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6001179-15
WI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/15/2023
Last updated
07/25/2023
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