Provider Demographics
NPI:1609543305
Name:JUN S KIM DDS INC
Entity Type:Organization
Organization Name:JUN S KIM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUN SIK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-817-4080
Mailing Address - Street 1:2366 E PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-5950
Mailing Address - Country:US
Mailing Address - Phone:754-610-2356
Mailing Address - Fax:
Practice Address - Street 1:1270 N LEMOORE AVE
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2350
Practice Address - Country:US
Practice Address - Phone:559-817-4080
Practice Address - Fax:559-817-4081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty