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General NPI Number Information
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NPI Number | 1457476137
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Entity Type | Organization
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Legal Business Name | RA AND KIM DENTAL CORP
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 42002 FOX FARM ROAD #101
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City | BIG BEAR LAKE
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State | CA
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Zip | 92315-6951
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Country | US
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Telephone | 909-866-0606
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Fax | 909-866-5546
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Provider Business Mailing Address
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Address Line | PO BOX 6951 42002 FOX FARM ROAD #101
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City | BIG BEAR LAKE
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State | CA
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Zip | 92315-6951
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Country | US
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Telephone | 909-866-0606
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Fax | 909-866-5546
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PHIL JAE RA
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Credential | D.D.S.
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Telephone | 909-866-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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