Provider Demographics
NPI:1669641569
Name:DR. HENRY KIM DDS INC.
Entity Type:Organization
Organization Name:DR. HENRY KIM DDS INC.
Other - Org Name:CROSS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-967-9954
Mailing Address - Street 1:5414 SUNRISE BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7803
Mailing Address - Country:US
Mailing Address - Phone:916-967-9953
Mailing Address - Fax:
Practice Address - Street 1:5414 SUNRISE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7803
Practice Address - Country:US
Practice Address - Phone:916-967-9953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty