Provider Demographics
NPI:1013120468
Name:IM, EUNICE Y (DDS)
Entity Type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:Y
Last Name:IM
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 1:6161 TEMPLE CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1748
Mailing Address - Country:US
Mailing Address - Phone:626-445-8600
Mailing Address - Fax:626-445-8601
Practice Address - Street 1:715 S 1ST AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7525
Practice Address - Country:US
Practice Address - Phone:626-445-8600
Practice Address - Fax:626-445-8601
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry