Provider Demographics
NPI:1164791646
Name:UNITED DENTAL WILSHIRE CORPORATION
Entity Type:Organization
Organization Name:UNITED DENTAL WILSHIRE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO, & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JEONG
Authorized Official - Middle Name:HOON
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-386-6700
Mailing Address - Street 1:3800 WILSHIRE BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3800 WILSHIRE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3231
Practice Address - Country:US
Practice Address - Phone:213-386-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty