Provider Demographics
NPI:1437477064
Name:KIM&PARK A DENTAL CORPORATION
Entity Type:Organization
Organization Name:KIM&PARK A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-656-0088
Mailing Address - Street 1:3400 S LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5217
Mailing Address - Country:US
Mailing Address - Phone:323-734-2284
Mailing Address - Fax:323-734-3178
Practice Address - Street 1:3400 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-5217
Practice Address - Country:US
Practice Address - Phone:323-734-2284
Practice Address - Fax:323-734-3178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIM&PARK A DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty