Individual
ELLEN KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MSD
Contact information
Practice address
3062 W COOLIDGE AVE APT 1, ANAHEIM, CA 92801-6110
(562) 405-4997
Mailing address
3062 W COOLIDGE AVE APT 1, ANAHEIM, CA 92801-6110
(562) 405-4997
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
108112
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108112
CALIFORNIA DENTAL BOARD
CA
Enumeration date
09/23/2022
Last updated
09/23/2022
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