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General NPI Number Information
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NPI Number | 1588084040
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Entity Type | Organization
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Legal Business Name | JANG KIL YI DDS PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 5914 PACIFIC BLVD
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-2929
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Country | US
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Telephone | 323-581-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 5914 PACIFIC BLVD
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-2929
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JANG KIL YI
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Credential | D.D.S.
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Telephone | 323-581-0100
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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 | 28641
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License Number State | CA
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