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General NPI Number Information
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NPI Number | 1043910110
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Entity Type | Organization
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Legal Business Name | JJ KIM DENTAL CORPORATION
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1721 W KATELLA AVE STE A
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City | ANAHEIM
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State | CA
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Zip | 92804-6195
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Country | US
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Telephone | 714-772-5656
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Fax |
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Provider Business Mailing Address
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Address Line | 230 E 17TH ST STE 208
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City | COSTA MESA
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State | CA
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Zip | 92627-3898
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Country | US
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Telephone | 949-645-0045
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES KIM
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Credential |
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Telephone | 949-445-5355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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