Provider Demographics
NPI:1578736872
Name:MIN SEOK KIM DDS INC
Entity Type:Organization
Organization Name:MIN SEOK KIM DDS INC
Other - Org Name:PREMIERE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIN
Authorized Official - Middle Name:SEOK
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:213-249-2319
Mailing Address - Street 1:3680 WILSHIRE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2713
Mailing Address - Country:US
Mailing Address - Phone:213-739-8855
Mailing Address - Fax:213-739-8899
Practice Address - Street 1:3680 WILSHIRE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2713
Practice Address - Country:US
Practice Address - Phone:213-739-8855
Practice Address - Fax:213-739-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty