Provider Demographics
NPI:1609927896
Name:KIM, JENNY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:A
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14150 CULVER DR
Mailing Address - Street 2:STE 305
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0323
Mailing Address - Country:US
Mailing Address - Phone:949-654-5511
Mailing Address - Fax:
Practice Address - Street 1:1538 E COLLINS AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5934
Practice Address - Country:US
Practice Address - Phone:714-532-1139
Practice Address - Fax:714-532-1233
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice