Provider Demographics
NPI:1578631503
Name:KIM, EMMA Y (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:Y
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 MONUMENT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3859
Mailing Address - Country:US
Mailing Address - Phone:310-454-4316
Mailing Address - Fax:310-454-3168
Practice Address - Street 1:984 MONUMENT ST STE 202
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3859
Practice Address - Country:US
Practice Address - Phone:310-454-4316
Practice Address - Fax:310-454-3168
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist