Provider Demographics
NPI:1881439016
Name:JI IN KIM, D.D.S., PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JI IN KIM, D.D.S., PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JI
Authorized Official - Middle Name:IN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-642-1386
Mailing Address - Street 1:150 E CENTENNIAL PKWY STE 113
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-1338
Mailing Address - Country:US
Mailing Address - Phone:702-642-1386
Mailing Address - Fax:702-642-6321
Practice Address - Street 1:150 E CENTENNIAL PKWY STE 113
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-1338
Practice Address - Country:US
Practice Address - Phone:702-642-1386
Practice Address - Fax:702-642-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty