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General NPI Number Information
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NPI Number | 1962545103
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Entity Type | Organization
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Legal Business Name | UCLA SCHOOL OF DENTISTRY ESTHETIC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 10833 LE CONTE AVE RM 33-064A
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City | LOS ANGELES
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State | CA
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Zip | 90095-3075
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Country | US
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Telephone | 310-825-4736
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Fax | 310-267-2656
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Provider Business Mailing Address
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Address Line | 10833 LE CONTE AVE. CHS 33-064
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City | LOS ANGELES
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State | CA
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Zip | 90095-1668
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Country | US
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Telephone | 310-825-4736
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Fax | 310-267-2656
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Authorized Official
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Title or Position | DIVISION CHAIR
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Name | DR. REUBEN KIM
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Credential | DDS
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Telephone | 310-825-7312
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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 | 21347
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License Number State | CA
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