Provider Demographics
NPI:1043664162
Name:KIM, CHERYL EUNU
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:EUNU
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4377 OCEAN VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1275
Mailing Address - Country:US
Mailing Address - Phone:412-639-2666
Mailing Address - Fax:
Practice Address - Street 1:1050 S GRAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-4284
Practice Address - Country:US
Practice Address - Phone:213-568-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist