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Individual

DR. JAE KIM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.D.S

Contact information

Practice address
144 BOSTON AVE, BRIDGEPORT, CT 06610-1604
(203) 437-7561
Mailing address
1955 LAKE AVE, ALTADENA, CA 91001-3037

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
65151
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
12130
CT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
65151
CA

Other

Enumeration date
10/28/2015
Last updated
03/17/2018
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