Provider Demographics
NPI:1700105681
Name:KIM, CLARA (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 E. SECOND ST.
Mailing Address - Street 2:SUITE 8
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-706-3910
Mailing Address - Fax:909-469-8650
Practice Address - Street 1:795 E. SECOND ST.
Practice Address - Street 2:SUITE 8
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766
Practice Address - Country:US
Practice Address - Phone:909-706-3910
Practice Address - Fax:909-469-8650
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568651223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics