Individual
JISU KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12444
CT
122300000X
Dentist
35909
TX
122300000X
Dentist
DE60997067
WA
122300000X
Dentist
DS040530
PA
122300000X
Dentist
Primary
DT-2882
HI
Other
Enumeration date
01/22/2019
Last updated
09/22/2024
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