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General NPI Number Information
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NPI Number | 1073854139
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Entity Type | Organization
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Legal Business Name | DJ DENTAL GROUP, KIM & KIM PROFESSIONAL CORP
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 4887 LA PALMA AVE
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City | LA PALMA
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State | CA
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Zip | 90623-2019
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Country | US
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Telephone | 714-778-6614
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Fax | 562-402-6377
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Provider Business Mailing Address
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Address Line | 4887 LA PALMA AVE
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City | LA PALMA
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State | CA
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Zip | 90623-2019
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Country | US
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Telephone | 714-778-6614
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Fax | 562-402-6377
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOOWON KIM
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Credential | D.D.S.
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Telephone | 714-778-6614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 54886
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 54775
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License Number State | CA
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