Provider Demographics
NPI:1598994949
Name:EUNICE Y. IM, D.D.S., INC.
Entity Type:Organization
Organization Name:EUNICE Y. IM, D.D.S., INC.
Other - Org Name:KIDVENTURE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:YUNSUN
Authorized Official - Last Name:IM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-445-8600
Mailing Address - Street 1:715 S. FIRST AVE.
Mailing Address - Street 2:SUITE D
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006
Mailing Address - Country:US
Mailing Address - Phone:626-445-8600
Mailing Address - Fax:626-445-8601
Practice Address - Street 1:715 S. FIRST AVE.
Practice Address - Street 2:SUITE D
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006
Practice Address - Country:US
Practice Address - Phone:626-445-8600
Practice Address - Fax:626-445-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty