Provider Demographics
NPI:1639504749
Name:ANDREW-SUNJUN KIM, D.D.S, INC.
Entity Type:Organization
Organization Name:ANDREW-SUNJUN KIM, D.D.S, INC.
Other - Org Name:ALLEGRA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW-SUNJUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-738-5525
Mailing Address - Street 1:12791 NEWPORT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2751
Mailing Address - Country:US
Mailing Address - Phone:714-832-8000
Mailing Address - Fax:
Practice Address - Street 1:12791 NEWPORT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2751
Practice Address - Country:US
Practice Address - Phone:714-832-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA620181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty