Provider Demographics
NPI:1598044356
Name:JD KIM MD, DDS, INC
Entity Type:Organization
Organization Name:JD KIM MD, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEONG
Authorized Official - Middle Name:DOO
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:310-713-5159
Mailing Address - Street 1:20760 PASEO DE LA RAMBLA
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887
Mailing Address - Country:US
Mailing Address - Phone:310-713-5159
Mailing Address - Fax:951-687-7448
Practice Address - Street 1:4000 TYLER ST STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3458
Practice Address - Country:US
Practice Address - Phone:951-687-4460
Practice Address - Fax:951-687-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty