Individual
KITAE KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
436 LANCASTER DR NE, SALEM, OR 97301-4728
(503) 391-8920
Mailing address
17821 SW LOCKWOOD CT, SHERWOOD, OR 97140-6131
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12058
OR
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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