Healthcare Provider Details

I. General information

NPI: 1104754407
Provider Name (Legal Business Name): BARDI-ZHUJIANG-LEE DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N BRAND BLVD STE 101
GLENDALE CA
91202-2567
US

IV. Provider business mailing address

1110 N BRAND BLVD STE 101
GLENDALE CA
91202-2567
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-4770
  • Fax:
Mailing address:
  • Phone: 818-242-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: HA REEM KIM
Title or Position: REGIONAL MANAGER
Credential:
Phone: 619-254-8656