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General NPI Number Information
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NPI Number | 1841316437
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Entity Type | Organization
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Legal Business Name | DR. JEFFREY J KIM'S DENTAL, INC.
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 784 N D STREET
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City | SAN BERNARDINO
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State | CA
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Zip | 92401
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Country | US
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Telephone | 909-884-4733
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Fax | 909-884-0668
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Provider Business Mailing Address
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Address Line | 784 N D STREET
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City | SAN BERNARDINO
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State | CA
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Zip | 92401
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Country | US
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Telephone | 909-884-4733
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Fax | 909-884-0668
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY J KIM
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Credential |
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Telephone | 909-884-4733
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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 | 40252
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License Number State | CA
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