Provider Demographics
NPI:1710107305
Name:JOHN Y KIM DDS, PC
Entity type:Organization
Organization Name:JOHN Y KIM DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-975-9775
Mailing Address - Street 1:14545 W GRAND AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7278
Mailing Address - Country:US
Mailing Address - Phone:623-975-9775
Mailing Address - Fax:623-975-9449
Practice Address - Street 1:14545 W GRAND AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7278
Practice Address - Country:US
Practice Address - Phone:623-975-9775
Practice Address - Fax:623-975-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty