Provider Demographics
NPI:1215209572
Name:ISMILE DENTAL
Entity Type:Organization
Organization Name:ISMILE DENTAL
Other - Org Name:KIMBERLY KIM DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD PHD
Authorized Official - Phone:650-282-5555
Mailing Address - Street 1:1702 MIRAMONTE AVE.
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040
Mailing Address - Country:US
Mailing Address - Phone:650-282-5555
Mailing Address - Fax:650-282-5051
Practice Address - Street 1:1702 MIRAMONTE AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040
Practice Address - Country:US
Practice Address - Phone:650-282-5555
Practice Address - Fax:650-282-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty