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General NPI Number Information
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NPI Number | 1023415684
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Entity Type | Organization
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Legal Business Name | HO JUNG KIM DDS INC
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 444 N HARBOR BLVD SUITE 240
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City | FULLERTON
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State | CA
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Zip | 92832-1979
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Country | US
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Telephone | 714-526-5200
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Fax | 714-526-5656
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Provider Business Mailing Address
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Address Line | 444 N HARBOR BLVD SUITE 240
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City | FULLERTON
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State | CA
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Zip | 92832-1979
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Country | US
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Telephone | 714-526-5200
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Fax | 714-526-5656
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HO JUNG KIM
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Credential | DDS
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Telephone | 213-393-0290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 58423
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License Number State | CA
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