Provider Demographics
NPI:1366636607
Name:RICK T KIM DDS INC.
Entity Type:Organization
Organization Name:RICK T KIM DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-867-5117
Mailing Address - Street 1:10106 ALONDRA BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-3904
Mailing Address - Country:US
Mailing Address - Phone:562-867-5117
Mailing Address - Fax:562-867-8343
Practice Address - Street 1:10106 ALONDRA BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3904
Practice Address - Country:US
Practice Address - Phone:562-867-5117
Practice Address - Fax:562-867-8343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA DENTAL GROUP OF BELLFLOWER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-29
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty