Individual
YOON JEONG KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
11092 ANDERSON STREET, LLU SCHOOL OF DENTISTRY, LOMA LINDA, CA 92350-0001
(909) 558-4613
(909) 558-4192
Mailing address
11092 ANDERSON STREET, LLU SCHOOL OF DENTISTRY, LOMA LINDA, CA 92350-0001
(909) 558-4613
(909) 558-4192
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
55437
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55437
STATE LICENSE
CA
Enumeration date
08/29/2008
Last updated
08/29/2008
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