Provider Demographics
NPI:1972906808
Name:KANG & KIM DDS, INC
Entity Type:Organization
Organization Name:KANG & KIM DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHOON
Authorized Official - Middle Name:KYUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-331-0333
Mailing Address - Street 1:451 N AZUSA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-1348
Mailing Address - Country:US
Mailing Address - Phone:626-331-0333
Mailing Address - Fax:626-331-8307
Practice Address - Street 1:451 N AZUSA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-1348
Practice Address - Country:US
Practice Address - Phone:626-331-0333
Practice Address - Fax:626-331-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty