Provider Demographics
NPI:1629251954
Name:JAMES MYUNG JU KIM DDS INC
Entity Type:Organization
Organization Name:JAMES MYUNG JU KIM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MYUNG JU
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-679-0697
Mailing Address - Street 1:3800 W EL SEGUNDO BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4677
Mailing Address - Country:US
Mailing Address - Phone:310-679-0697
Mailing Address - Fax:310-679-9813
Practice Address - Street 1:3800 W EL SEGUNDO BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4677
Practice Address - Country:US
Practice Address - Phone:310-679-0697
Practice Address - Fax:310-679-9813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty