Healthcare Provider Details

I. General information

NPI: 1295656809
Provider Name (Legal Business Name): KO & KIM DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27674 NEWHALL RANCH RD # C75
VALENCIA CA
91355-4018
US

IV. Provider business mailing address

27674 NEWHALL RANCH RD # C75
VALENCIA CA
91355-4018
US

V. Phone/Fax

Practice location:
  • Phone: 661-235-0258
  • Fax:
Mailing address:
  • Phone: 661-235-0258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAEMIN KO
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 650-476-7300