Provider Demographics
NPI:1386851525
Name:S.S. KIM, D.D.S. INC.
Entity Type:Organization
Organization Name:S.S. KIM, D.D.S. INC.
Other - Org Name:GP DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG-KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-377-2278
Mailing Address - Street 1:1410 N GAREY AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3810
Mailing Address - Country:US
Mailing Address - Phone:909-623-8535
Mailing Address - Fax:909-623-8230
Practice Address - Street 1:1410 N GAREY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3810
Practice Address - Country:US
Practice Address - Phone:909-623-8535
Practice Address - Fax:909-623-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB39026-01OtherDENTICAL
CA829626OtherUNITED CONCORDIA