Provider Demographics
NPI:1962829143
Name:KIM, HA, AND SAGONG DENTAL CORP
Entity Type:Organization
Organization Name:KIM, HA, AND SAGONG DENTAL CORP
Other - Org Name:ORAL MAXILLOFACIALSURGERY INSTITUTE - LOS ANGELES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEE HOON
Authorized Official - Middle Name:
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-550-8701
Mailing Address - Street 1:266 S HARVARD BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3854
Mailing Address - Country:US
Mailing Address - Phone:213-999-7950
Mailing Address - Fax:213-797-5579
Practice Address - Street 1:266 S HARVARD BLVD STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3854
Practice Address - Country:US
Practice Address - Phone:213-999-7590
Practice Address - Fax:213-797-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty