Provider Demographics
NPI:1518117324
Name:KIM, ENOTH DOUGWON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ENOTH
Middle Name:DOUGWON
Last Name:KIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 EAST CENTER AVE.
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6331
Mailing Address - Country:US
Mailing Address - Phone:559-737-4700
Mailing Address - Fax:559-737-4782
Practice Address - Street 1:323 WEST PUTNAM AVE.
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3466
Practice Address - Country:US
Practice Address - Phone:559-784-5465
Practice Address - Fax:559-784-0280
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist