Healthcare Provider Details

I. General information

NPI: 1124471941
Provider Name (Legal Business Name): JUNIL KIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2016
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6423 VINELAND AVE
NORTH HOLLYWOOD CA
91606-2712
US

IV. Provider business mailing address

1050 S GRAND AVE UNIT 1709
LOS ANGELES CA
90015-4292
US

V. Phone/Fax

Practice location:
  • Phone: 818-432-2199
  • Fax:
Mailing address:
  • Phone: 253-224-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS042670
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDDS111018
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS042670
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: