Provider Demographics
NPI:1184829830
Name:KENNETH H KIM,DDS, A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:KENNETH H KIM,DDS, A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:HYON MO
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-550-0006
Mailing Address - Street 1:2723 N BRISTOL ST
Mailing Address - Street 2:SUITE #D-2
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-1419
Mailing Address - Country:US
Mailing Address - Phone:714-550-0006
Mailing Address - Fax:714-550-0007
Practice Address - Street 1:2723 N BRISTOL ST
Practice Address - Street 2:SUITE #D-2
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-1419
Practice Address - Country:US
Practice Address - Phone:714-550-0006
Practice Address - Fax:714-550-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty