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General NPI Number Information
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NPI Number | 1619761871
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Entity Type | Organization
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Legal Business Name | ERIC DUKJU KIM DDS, INC.
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Dates
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Enumeration Date | 04/04/2025
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 5129 CANDLEWOOD ST
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City | LAKEWOOD
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State | CA
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Zip | 90712-1921
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Country | US
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Telephone | 213-675-5777
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Fax |
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Provider Business Mailing Address
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Address Line | 13157 SEMORA PL
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City | CERRITOS
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State | CA
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Zip | 90703-8630
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Country | US
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Telephone | 213-675-5777
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ERIC KIM
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Credential |
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Telephone | 213-675-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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