Provider Demographics
NPI:1952782070
Name:DOUGLAS KIM DDS INC
Entity Type:Organization
Organization Name:DOUGLAS KIM DDS INC
Other - Org Name:FIRST DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-217-3382
Mailing Address - Street 1:2801 W BALL RD
Mailing Address - Street 2:#10
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4900
Mailing Address - Country:US
Mailing Address - Phone:714-527-5656
Mailing Address - Fax:714-527-7412
Practice Address - Street 1:2801 W BALL RD
Practice Address - Street 2:#10
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-4900
Practice Address - Country:US
Practice Address - Phone:714-527-5656
Practice Address - Fax:714-527-7412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA631291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083045173OtherNPI TYPE 1