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General NPI Number Information
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NPI Number | 1962919571
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Entity Type | Organization
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Legal Business Name | GITAE KIM DENTAL GROUP INC
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 3054 W 8TH ST STE 106
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City | LOS ANGELES
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State | CA
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Zip | 90005-1895
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Country | US
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Telephone | 213-384-2864
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Fax | 213-384-2386
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Provider Business Mailing Address
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Address Line | 3054 W 8TH ST STE 106
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City | LOS ANGELES
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State | CA
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Zip | 90005-1895
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Country | US
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Telephone | 213-384-2864
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Fax | 213-384-2386
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Authorized Official
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Title or Position | DENTIST AND OWNER
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Name | DR. GITAE KIM
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Credential | DDS
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Telephone | 213-384-2864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 58750
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License Number State | CA
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