Provider Demographics
NPI:1558550137
Name:RICK T. KIM DDS. INC.
Entity Type:Organization
Organization Name:RICK T. KIM DDS. INC.
Other - Org Name:MONTEBELLO DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-838-8055
Mailing Address - Street 1:2332 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3039
Mailing Address - Country:US
Mailing Address - Phone:323-838-8055
Mailing Address - Fax:323-838-8057
Practice Address - Street 1:2332 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3039
Practice Address - Country:US
Practice Address - Phone:323-838-8055
Practice Address - Fax:323-838-8057
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICK T KIM DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty