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General NPI Number Information
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NPI Number | 1285168641
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Entity Type | Organization
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Legal Business Name | HENNA KIM DENTAL CORP.
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 500 E COLORADO ST # 200
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City | GLENDALE
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State | CA
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Zip | 91205-1607
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Country | US
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Telephone | 949-697-3232
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Fax |
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Provider Business Mailing Address
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Address Line | 2060 BARNETT RD
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City | LOS ANGELES
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State | CA
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Zip | 90032-4102
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Country | US
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Telephone | 949-697-3232
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ORTHODONTIST
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Name | DR. HENNA KIM
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Credential |
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Telephone | 949-697-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 58338
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License Number State | CA
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