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General NPI Number Information
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NPI Number | 1104336478
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Entity Type | Organization
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Legal Business Name | LOUIS M KIM, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1824 AVONDALE AVE
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City | SACRAMENTO
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State | CA
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Zip | 95825-1378
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Country | US
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Telephone | 916-900-8521
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Fax | 916-900-8526
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Provider Business Mailing Address
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Address Line | 1824 AVONDALE AVE
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City | SACRAMENTO
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State | CA
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Zip | 95825-1378
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Country | US
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Telephone | 916-900-8521
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Fax | 916-900-8526
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | LOUIS KIM
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Credential | DDS
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Telephone | 916-900-8521
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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 | 53231
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License Number State | CA
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