Provider Demographics
NPI:1043927015
Name:JAE EUN KIM, DMD DENTISTRY INC
Entity Type:Organization
Organization Name:JAE EUN KIM, DMD DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JAE EUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-699-1000
Mailing Address - Street 1:8819 WHITTIER BLVD STE 102-103
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-2672
Mailing Address - Country:US
Mailing Address - Phone:562-699-1000
Mailing Address - Fax:562-699-1099
Practice Address - Street 1:8819 WHITTIER BLVD STE 102-103
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2672
Practice Address - Country:US
Practice Address - Phone:562-699-1000
Practice Address - Fax:562-699-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental