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4635 E Avenue S # C103 Palmdale CA 93552-4483 | |
(661) 349-8280 | |
(661) 349-4462 |
Full Name | |
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Speciality | Dentist |
Location | 4635 E Avenue S, Palmdale, California |
Authorized Official Name and Position | Song K Kim (PRESIDENT) |
Authorized Official Contact | 6613498280 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4635 E Avenue S # C103 Palmdale CA 93552-4483 Ph: (661) 349-8280 | 4635 E Avenue S # C103 Palmdale CA 93552-4483 Ph: (661) 349-8280 |
NPI Number | 1386192821 |
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Provider Enumeration Date | 09/13/2016 |
Last Update Date | 11/21/2017 |
Identifier | Type | State | Issuer |
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1386192821 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 58863 (California) | Primary |