MEDICARE: HEIVI KIM DENTAL 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	261QD0000X	Dental Clinic/Center	63356	CA

General Provider Information

NPI Number	:	1982120721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEIVI KIM DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2321 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5620
Country	:	US
Telephone Number	:	213-718-0811
Fax Number	:

Provider Business Practice Location Address
First Line	:	2321 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5620
Country	:	US
Telephone Number	:	213-718-0811
Fax Number	:

Authorized Official
Title or Position	:	DDS/OWNER
Name	:	HEIVI KIM
Credential	:	DDS
Telephone Number	:	213-718-0811

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	02/04/2021

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