Provider Demographics
NPI:1578923843
Name:EUGENE KIM DDS INC
Entity Type:Organization
Organization Name:EUGENE KIM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-279-1004
Mailing Address - Street 1:7825 ENGINEER RD
Mailing Address - Street 2:STE 111
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-1924
Mailing Address - Country:US
Mailing Address - Phone:858-279-1004
Mailing Address - Fax:858-268-1004
Practice Address - Street 1:7825 ENGINEER RD
Practice Address - Street 2:STE 111
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-1924
Practice Address - Country:US
Practice Address - Phone:858-279-1004
Practice Address - Fax:858-268-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA526231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty