Provider Demographics
NPI:1063687937
Name:JIN Y. KIM DDS, INC.
Entity Type:Organization
Organization Name:JIN Y. KIM DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-445-6144
Mailing Address - Street 1:9681 GARDEN GROVE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1548
Mailing Address - Country:US
Mailing Address - Phone:714-539-8275
Mailing Address - Fax:714-539-8284
Practice Address - Street 1:9681 GARDEN GROVE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1548
Practice Address - Country:US
Practice Address - Phone:713-539-8275
Practice Address - Fax:714-539-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545751223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty