Healthcare Provider Details

I. General information

NPI: 1871769109
Provider Name (Legal Business Name): JANICE Y. PARK-KIM, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3971 IRVINE BLVD STE. 102
IRVINE CA
92602-2482
US

IV. Provider business mailing address

3971 IRVINE BLVD STE. 102
IRVINE CA
92602-2482
US

V. Phone/Fax

Practice location:
  • Phone: 714-368-3319
  • Fax:
Mailing address:
  • Phone: 714-368-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number48658
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number43617
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES KIM
Title or Position: VICE PRESIDENT
Credential:
Phone: 714-368-3319