Individual
CHANYOUNG KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
25022 PROSPECT AVE APT B, LOMA LINDA, CA 92354-2955
(951) 776-6037
Mailing address
25022 PROSPECT AVE APT B, LOMA LINDA, CA 92354-2955
(951) 776-6037
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
106313
CA
Other
Enumeration date
09/26/2021
Last updated
09/26/2021
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