Provider Demographics
NPI:1346319084
Name:B C KIM DDS INC
Entity Type:Organization
Organization Name:B C KIM DDS INC
Other - Org Name:HESPERIA CENTRAL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-244-4844
Mailing Address - Street 1:16922 MAIN ST
Mailing Address - Street 2:SUITE # F
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-7920
Mailing Address - Country:US
Mailing Address - Phone:760-244-4844
Mailing Address - Fax:760-244-5002
Practice Address - Street 1:16922 MAIN ST
Practice Address - Street 2:SUITE # F
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-7920
Practice Address - Country:US
Practice Address - Phone:760-244-4844
Practice Address - Fax:760-244-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9358301OtherMEDI-CAL DENTAL PROGRAM