Provider Demographics
NPI:1437728383
Name:JHKK PERIODONTICS, PLLC
Entity Type:Organization
Organization Name:JHKK PERIODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER IN PRACTICE/PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIP
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSEANES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MSD
Authorized Official - Phone:843-530-4854
Mailing Address - Street 1:2273 S VISTA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-7350
Mailing Address - Country:US
Mailing Address - Phone:208-377-2777
Mailing Address - Fax:208-377-3075
Practice Address - Street 1:2273 S VISTA AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-7350
Practice Address - Country:US
Practice Address - Phone:208-377-2777
Practice Address - Fax:208-377-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty