Provider Demographics
NPI:1972913655
Name:JIN KIM DENTAL CORPORATION
Entity Type:Organization
Organization Name:JIN KIM DENTAL CORPORATION
Other - Org Name:SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIN HYUK
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-363-6125
Mailing Address - Street 1:12190 PERRIS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557
Mailing Address - Country:US
Mailing Address - Phone:951-486-0550
Mailing Address - Fax:
Practice Address - Street 1:12190 PERRIS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557
Practice Address - Country:US
Practice Address - Phone:951-486-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
48484122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty