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General NPI Number Information
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NPI Number | 1730310962
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Entity Type | Organization
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Legal Business Name | MI SUNG HEO-KIM, DDS, INC.
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 5814 RIVERSIDE DR
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City | CHINO
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State | CA
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Zip | 91710-4457
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Country | US
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Telephone | 909-548-4844
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Fax | 909-548-0774
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Provider Business Mailing Address
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Address Line | 5814 RIVERSIDE DR
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City | CHINO
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State | CA
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Zip | 91710-4457
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Country | US
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Telephone | 909-548-4844
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Fax | 909-548-0774
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MI SUNG HEO-KIM
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Credential | DDS
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Telephone | 909-732-8786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 50766
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License Number State | CA
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