Provider Demographics
NPI:1023405719
Name:HOOVER DENTAL CENTER
Entity type:Organization
Organization Name:HOOVER DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SOO
Authorized Official - Middle Name:YEW
Authorized Official - Last Name:KIM DDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-747-6891
Mailing Address - Street 1:1717 S HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-4964
Mailing Address - Country:US
Mailing Address - Phone:213-747-6891
Mailing Address - Fax:213-747-5512
Practice Address - Street 1:1717 S HOOVER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4964
Practice Address - Country:US
Practice Address - Phone:213-747-6891
Practice Address - Fax:213-747-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35280261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental