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General NPI Number Information
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NPI Number | 1558553511
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Entity Type | Organization
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Legal Business Name | CHUNG KIM DENTAL CORPORATION
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 204 E WARNER AVE STE 104
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City | SANTA ANA
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State | CA
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Zip | 92707-3277
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Country | US
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Telephone | 714-641-2939
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Fax | 714-641-2868
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Provider Business Mailing Address
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Address Line | 204 E WARNER AVE STE 104
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City | SANTA ANA
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State | CA
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Zip | 92707-3277
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Country | US
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Telephone | 714-641-2939
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Fax | 714-641-2868
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHUNG KIM
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Credential | D.D.S.
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Telephone | 949-838-4733
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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 | 26442
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License Number State | CA
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