Provider Demographics
NPI:1083319800
Name:ERIC KIM DMD CORP
Entity Type:Organization
Organization Name:ERIC KIM DMD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-725-1785
Mailing Address - Street 1:501 N CORNELL AVE # 1
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-2744
Mailing Address - Country:US
Mailing Address - Phone:714-992-0092
Mailing Address - Fax:714-992-2154
Practice Address - Street 1:501 N CORNELL AVE # 1
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-2744
Practice Address - Country:US
Practice Address - Phone:714-992-0092
Practice Address - Fax:714-992-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty