Provider Demographics
NPI:1851550248
Name:KIM, JEFFREY J (DDS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:J
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 1:784 NORTH D STREET
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401
Mailing Address - Country:US
Mailing Address - Phone:909-884-4733
Mailing Address - Fax:909-884-0668
Practice Address - Street 1:784 NORTH D STREET
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401
Practice Address - Country:US
Practice Address - Phone:909-884-4733
Practice Address - Fax:909-884-0668
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist