Provider Demographics
NPI:1881859064
Name:GENE WOO KIM DDS INC
Entity type:Organization
Organization Name:GENE WOO KIM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:WOO
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-992-2166
Mailing Address - Street 1:1409 WHITLEY AVE
Mailing Address - Street 2:#C
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-2223
Mailing Address - Country:US
Mailing Address - Phone:559-992-2166
Mailing Address - Fax:
Practice Address - Street 1:1409 WHITLEY AVE
Practice Address - Street 2:#C
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2223
Practice Address - Country:US
Practice Address - Phone:559-992-2166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51272122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty