Provider Demographics
NPI:1710049887
Name:KIM, CHUN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHUN
Middle Name:K
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35900 BOB HOPE DRIVE STE 110
Mailing Address - Street 2:TMJ HEAD AND NECK PAIN CENTER
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-770-4033
Mailing Address - Fax:760-770-3975
Practice Address - Street 1:35900 BOB HOPE DRIVE STE 110
Practice Address - Street 2:TMJ HEAD AND NECK PAIN CENTER
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-770-4033
Practice Address - Fax:760-770-3975
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U09591Medicare UPIN
CADS0259200Medicare ID - Type Unspecified