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General NPI Number Information
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NPI Number | 1184335754
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Entity Type | Organization
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Legal Business Name | JOHNATHAN KIM D.D.S. DENTAL PRACTICE
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 1895 ORANGE TREE LN STE 101
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City | REDLANDS
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State | CA
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Zip | 92374-0112
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Country | US
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Telephone | 909-793-5270
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Fax |
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Provider Business Mailing Address
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Address Line | 61 DONOVAN
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City | IRVINE
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State | CA
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Zip | 92620-3882
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Country | US
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Telephone | 909-279-8323
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JOHNATHAN HYUN KIM
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Credential | DDS
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Telephone | 909-279-8323
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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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