Provider Demographics
NPI:1023415684
Name:HO JUNG KIM DDS INC
Entity type:Organization
Organization Name:HO JUNG KIM DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HO JUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-393-0290
Mailing Address - Street 1:444 N HARBOR BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1979
Mailing Address - Country:US
Mailing Address - Phone:714-526-5200
Mailing Address - Fax:714-526-5656
Practice Address - Street 1:444 N HARBOR BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1979
Practice Address - Country:US
Practice Address - Phone:714-526-5200
Practice Address - Fax:714-526-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty