Healthcare Provider Details

I. General information

NPI: 1114433703
Provider Name (Legal Business Name): JUN SIK KIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 N LEMOORE AVE
LEMOORE CA
93245-2350
US

IV. Provider business mailing address

2366 E PINEHURST AVE
FRESNO CA
93730-5950
US

V. Phone/Fax

Practice location:
  • Phone: 559-817-4080
  • Fax: 559-817-4081
Mailing address:
  • Phone: 754-610-2356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number51270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: