Provider Demographics
NPI:1174848923
Name:JI HYUN KIM DENTAL CORP.
Entity Type:Organization
Organization Name:JI HYUN KIM DENTAL CORP.
Other - Org Name:BEN MADDOX FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIHYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-210-4908
Mailing Address - Street 1:1404 N BEN MADDOX WAY
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-2246
Mailing Address - Country:US
Mailing Address - Phone:213-210-4908
Mailing Address - Fax:
Practice Address - Street 1:1404 N BEN MADDOX WAY
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-2246
Practice Address - Country:US
Practice Address - Phone:213-210-4908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty