Provider Demographics
NPI:1215730387
Name:KIM, MEAN JI (DMD)
Entity type:Individual
Prefix:DR
First Name:MEAN JI
Middle Name:
Last Name:KIM
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MIRA VALLE ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-5322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52-2, GWAJEONG-RO, SUYEONG-GU
Practice Address - Street 2:
Practice Address - City:BUSAN
Practice Address - State:KYUNGSANGNAMDO
Practice Address - Zip Code:48218
Practice Address - Country:KR
Practice Address - Phone:051-754-2875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12159832-9926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist