MEDICARE: HAK CHEON KIM DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	36394	CA

General Provider Information

NPI Number	:	1023141728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAK CHEON KIM DDS INC

Provider Business Mailing Address
First Line	:	5455 WILSHIRE BLVD # 850
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4201
Country	:	US
Telephone Number	:	323-930-4600
Fax Number	:	323-930-4604

Provider Business Practice Location Address
First Line	:	5455 WILSHIRE BLVD # 850
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4201
Country	:	US
Telephone Number	:	323-930-4600
Fax Number	:	323-930-4604

Authorized Official
Title or Position	:	CEO
Name	:	MR. HAK CHEON KIM
Credential	:	DDS
Telephone Number	:	323-930-4600

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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