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General NPI Number Information
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NPI Number | 1932478427
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Entity Type | Organization
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Legal Business Name | UNITED DENTAL IRVINE CORPORATION
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Dates
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Enumeration Date | 12/29/2011
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 15315 CULVER DR STE 185
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City | IRVINE
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State | CA
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Zip | 92604-7133
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Country | US
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Telephone | 949-551-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 15315 CULVER DR STE 185
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City | IRVINE
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State | CA
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Zip | 92604-7133
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO, CFO, & SECRETARY
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Name | JEONG HOON KIM
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Credential |
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Telephone | 949-551-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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