=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649148446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILLEL AND KIM DENTAL GROUP INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2025
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7604 RESEDA BLVD
-----------------------------------------------------
City | RESEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91335-2822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-343-3916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7604 RESEDA BLVD
-----------------------------------------------------
City | RESEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91335-2822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-343-3916
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JOHNNY KIM
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 818-343-3916
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------