Kim, Ellen
Kim, Ellen is an individual health care provider with primary practice located at 3062 W Coolidge Ave Apt 1 , Anaheim CA 92801-6110. She recently has only one registered license in Dental Providers / Orthodontics and Dentofacial Orthopedics, which is considered as her primary health care specialty. Kim, Ellen can be contacted via phone (562) 405-4997.Contact Information
Primary practice address
3062 W Coolidge Ave Apt 1
Anaheim CA 92801-6110
Phone: (562) 405-4997
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Orthodontics and Dentofacial Orthopedics | 1223X0400X | 108112 | California |
Profile Details
| NPI number | 1588387518 |
|---|---|
| LBN Legal business name | Kim, Ellen |
| Credentials | DMD, MSD |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 23rd, 2022 |
| Last updated | Sep 23rd, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588387518 | NPPES |
| California | Other | 108112 | CALIFORNIA DENTAL BOARD |
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