Provider Demographics
NPI:1376858175
Name:BOCK J. KIM, DDS, INC.
Entity Type:Organization
Organization Name:BOCK J. KIM, DDS, INC.
Other - Org Name:GRACE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOCK
Authorized Official - Middle Name:JUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-773-2082
Mailing Address - Street 1:6501 EASTERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3003
Mailing Address - Country:US
Mailing Address - Phone:323-773-2082
Mailing Address - Fax:323-560-3905
Practice Address - Street 1:6501 EASTERN AVE STE B
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-3003
Practice Address - Country:US
Practice Address - Phone:323-773-2082
Practice Address - Fax:323-560-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty