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General NPI Number Information
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NPI Number | 1972906808
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Entity Type | Organization
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Legal Business Name | KANG & KIM DDS, INC
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 451 N AZUSA AVE
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City | WEST COVINA
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State | CA
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Zip | 91791-1348
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Country | US
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Telephone | 626-331-0333
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Fax | 626-331-8307
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Provider Business Mailing Address
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Address Line | 451 N AZUSA AVE
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City | WEST COVINA
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State | CA
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Zip | 91791-1348
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Country | US
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Telephone | 626-331-0333
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Fax | 626-331-8307
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHOON KYUNG KIM
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Credential | D.D.S.
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Telephone | 626-331-0333
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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 | 41741
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License Number State | CA
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