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General NPI Number Information
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NPI Number | 1700919974
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Entity Type | Organization
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Legal Business Name | VALENCIA CHILDREN'S DENTAL GROUP
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 27885 SMYTH DR
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City | VALENCIA
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State | CA
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Zip | 91355-4011
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Country | US
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Telephone | 661-294-1800
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Fax | 661-294-9774
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Provider Business Mailing Address
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Address Line | 27885 SMYTH DR
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City | VALENCIA
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State | CA
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Zip | 91355-4011
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Country | US
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Telephone | 661-294-1800
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Fax | 661-294-9774
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROSE E KIM
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Credential | DDS
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Telephone | 661-294-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 41287
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 41287
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 39025
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License Number State | CA
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