Provider Demographics
NPI:1386192821
Name:SKIM DDS INC
Entity Type:Organization
Organization Name:SKIM DDS INC
Other - Org Name:PREMIER DENTAL SUITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONG
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-349-8280
Mailing Address - Street 1:4635 E AVENUE S
Mailing Address - Street 2:# C103
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-4483
Mailing Address - Country:US
Mailing Address - Phone:661-349-8280
Mailing Address - Fax:661-349-4462
Practice Address - Street 1:4635 E AVENUE S
Practice Address - Street 2:# C103
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4483
Practice Address - Country:US
Practice Address - Phone:661-349-8280
Practice Address - Fax:661-349-4462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty