Provider Demographics
NPI:1396912671
Name:KIM, JENNIFER Y (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:Y
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 1:401 GREGORY LN
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2800
Mailing Address - Country:US
Mailing Address - Phone:925-689-1020
Mailing Address - Fax:925-689-1028
Practice Address - Street 1:401 GREGORY LN
Practice Address - Street 2:SUITE 206
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2800
Practice Address - Country:US
Practice Address - Phone:925-689-1020
Practice Address - Fax:925-689-1028
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice