Provider Demographics
NPI:1629629134
Name:ANSONY KIM, DDS INC
Entity Type:Organization
Organization Name:ANSONY KIM, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANSONY
Authorized Official - Middle Name:JIN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-334-3622
Mailing Address - Street 1:PO BOX 4604
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-0604
Mailing Address - Country:US
Mailing Address - Phone:510-334-3622
Mailing Address - Fax:
Practice Address - Street 1:2591 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-1854
Practice Address - Country:US
Practice Address - Phone:925-690-5437
Practice Address - Fax:925-690-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty