Provider Demographics
NPI:1114594702
Name:UM, KI M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KI
Middle Name:M
Last Name:UM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 CERRITOS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4570
Mailing Address - Country:US
Mailing Address - Phone:347-688-6560
Mailing Address - Fax:
Practice Address - Street 1:5001 CERRITOS AVE STE A
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4570
Practice Address - Country:US
Practice Address - Phone:347-688-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist