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General NPI Number Information
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NPI Number | 1962829143
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Entity Type | Organization
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Legal Business Name | KIM, HA, AND SAGONG DENTAL CORP
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 266 S HARVARD BLVD STE 220
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City | LOS ANGELES
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State | CA
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Zip | 90004-3854
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Country | US
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Telephone | 213-999-7590
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Fax | 213-797-5579
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Provider Business Mailing Address
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Address Line | 266 S HARVARD BLVD STE 220
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City | LOS ANGELES
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State | CA
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Zip | 90004-3854
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Country | US
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Telephone | 213-999-7950
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Fax | 213-797-5579
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. JEE HOON HA
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Credential | DDS
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Telephone | 213-550-8701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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