Provider Demographics
NPI:1982118469
Name:KIM, JENNY H (RDH)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:H
Last Name:KIM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 FOLLYHATCH
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1051
Mailing Address - Country:US
Mailing Address - Phone:949-679-7606
Mailing Address - Fax:
Practice Address - Street 1:10602 CHAPMAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3147
Practice Address - Country:US
Practice Address - Phone:714-537-0700
Practice Address - Fax:714-537-0733
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19011124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist