Provider Demographics
NPI:1336275338
Name:KIM, JANGSOOK (DDS)
Entity Type:Individual
Prefix:
First Name:JANGSOOK
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23501 CINEMA DR. #114
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1818
Mailing Address - Country:US
Mailing Address - Phone:661-253-3030
Mailing Address - Fax:661-253-3468
Practice Address - Street 1:23501 CINEMA DR. #114
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:661-253-3030
Practice Address - Fax:661-253-3468
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice