Provider Demographics
NPI:1437526357
Name:HI DENTAL CARE LLC
Entity Type:Organization
Organization Name:HI DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOUNGCHUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-334-3544
Mailing Address - Street 1:32 UPPER PATTAGANSETT RD
Mailing Address - Street 2:UNIT 30
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1147
Mailing Address - Country:US
Mailing Address - Phone:917-334-3544
Mailing Address - Fax:
Practice Address - Street 1:598 W MAIN ST
Practice Address - Street 2:UNIT 3
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-5342
Practice Address - Country:US
Practice Address - Phone:917-334-3544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010809261QD0000X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1235445354Medicaid
CT1629384987Medicaid