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Dr. Ellen Wonsun Im, DDS
Pediatric Dentist in Poway, California
NPI 1023029220

Ellen Wonsun Im is a Pediatric Dentist based in Poway, CA and is specialized in Pediatric Dentistry. Ellen Wonsun Im practices in Poway, CA and has the professional credentials of DDS. The NPI Number for Ellen Wonsun Im is 1023029220 and holds a License No. 63073 (California).

The current practice location address for Ellen Wonsun Im is 13422 Pomerado Rd Ste 201, Poway, CA and can be reached out via phone at 410-644-4100.

Location: 13422 Pomerado Rd Ste 201, Poway, CA, 92064
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1023029220
Provider Name
Ellen Wonsun Im
Credential
DDS
Provider Entity Type
Individual
Gender
Female
Address
13422 Pomerado Rd Ste 201, Poway, CA, 92064
Phone Number
410-644-4100
Fax Number
Provider Enumeration Date
08/11/2006
Last Update Date
03/08/2024
institution
Provider Business Practice Location Address Details
Address
13422 Pomerado Rd Ste 201
City
Poway
State
California
Zip
92064-3548
Phone Number
410-644-4100
Fax Number
person
Provider Business Mailing Address Details
Address
13422 Pomerado Rd Ste 201
City
Poway
State
California
Zip
92064-3548
Phone Number
410-644-4100
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
Pediatric Dentistry
Taxonomy
1223P0221X
License No.
63073 (California)
Definition
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.
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