Provider Demographics
NPI:1982643110
Name:KIM, JONE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONE
Middle Name:
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 1:400 W CENTRAL AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3013
Mailing Address - Country:US
Mailing Address - Phone:714-529-0043
Mailing Address - Fax:714-529-1019
Practice Address - Street 1:400 W CENTRAL AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3013
Practice Address - Country:US
Practice Address - Phone:714-529-0043
Practice Address - Fax:714-529-1019
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery