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General NPI Number Information
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NPI Number | 1215066790
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Entity Type | Organization
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Legal Business Name | HARRY C KIM DDS INC.
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15400 CRENSHAW BLVD
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City | GARDENA
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State | CA
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Zip | 90249-4524
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Country | US
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Telephone | 310-516-9858
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Fax | 310-516-9658
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Provider Business Mailing Address
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Address Line | 15400 CRENSHAW BLVD
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City | GARDENA
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State | CA
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Zip | 90249-4524
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Country | US
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Telephone | 310-516-9858
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Fax | 310-516-9658
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Authorized Official
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Title or Position | CEO
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Name | HARRY C KIM
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Credential | DDS
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Telephone | 310-516-9858
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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 | 48730
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License Number State | CA
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