MEDICARE: JOO KIM DENTAL PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1033922828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOO KIM DENTAL PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	4531 PHILADELPHIA ST STE B107
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-2249
Country	:	US
Telephone Number	:	213-595-1410
Fax Number	:

Provider Business Practice Location Address
First Line	:	4531 PHILADELPHIA ST STE B107
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-2249
Country	:	US
Telephone Number	:	213-595-1410
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOO HYUNG KIM
Credential	:	DDS
Telephone Number	:	213-595-1410

Provider Enumeration Date	:	01/28/2025
Last Update Date	:	01/28/2025

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