Provider Demographics
NPI:1982821666
Name:KIM, JAMES MYUNG JU (DDS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MYUNG JU
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 1:3800 W EL SEGUNDO BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-4677
Mailing Address - Country:US
Mailing Address - Phone:310-679-0697
Mailing Address - Fax:310-679-9813
Practice Address - Street 1:3800 W EL SEGUNDO BLVD
Practice Address - Street 2:STE 203
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4677
Practice Address - Country:US
Practice Address - Phone:310-679-0697
Practice Address - Fax:310-679-9813
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice