Healthcare Provider Details

I. General information

NPI: 1982882072
Provider Name (Legal Business Name): KIM SHIMAZU & LEE DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 BARRANCA PKWY SUITE 135A
IRVINE CA
92604
US

IV. Provider business mailing address

4040 BARRANCA PKWY SUITE 135A
IRVINE CA
92604
US

V. Phone/Fax

Practice location:
  • Phone: 949-262-1300
  • Fax:
Mailing address:
  • Phone: 949-262-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDT36953
License Number StateCA

VIII. Authorized Official

Name: MICHAEL H KIM
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-530-7888