Provider Demographics
NPI:1770820433
Name:KYUNGIEE GINA MUIR, D.D.S., INC.
Entity Type:Organization
Organization Name:KYUNGIEE GINA MUIR, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:
Authorized Official - First Name:KYUNGIEE
Authorized Official - Middle Name:GINA
Authorized Official - Last Name:MUIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-363-0300
Mailing Address - Street 1:10727 WHITE OAK AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4631
Mailing Address - Country:US
Mailing Address - Phone:818-363-0300
Mailing Address - Fax:818-363-7656
Practice Address - Street 1:10727 WHITE OAK AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4631
Practice Address - Country:US
Practice Address - Phone:818-363-0300
Practice Address - Fax:818-363-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty