Provider Demographics
NPI:1932465671
Name:RICK T. KIM DDS INC.
Entity Type:Organization
Organization Name:RICK T. KIM DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:TAE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-874-7444
Mailing Address - Street 1:1374 W FOOTHILL BLVD STE 2E
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4621
Mailing Address - Country:US
Mailing Address - Phone:909-874-7444
Mailing Address - Fax:909-874-7453
Practice Address - Street 1:1374 W FOOTHILL BLVD STE 2E
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4621
Practice Address - Country:US
Practice Address - Phone:909-874-7444
Practice Address - Fax:909-874-7453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICK T. KIM DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty