Provider Demographics
NPI:1073854139
Name:DJ DENTAL GROUP, KIM & KIM PROFESSIONAL CORP
Entity Type:Organization
Organization Name:DJ DENTAL GROUP, KIM & KIM PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOOWON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-778-6614
Mailing Address - Street 1:4887 LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-2019
Mailing Address - Country:US
Mailing Address - Phone:714-778-6614
Mailing Address - Fax:562-402-6377
Practice Address - Street 1:4887 LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-2019
Practice Address - Country:US
Practice Address - Phone:714-778-6614
Practice Address - Fax:562-402-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547751223G0001X
CA548861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty