Provider Demographics
NPI:1376215251
Name:KJ KIM DENTAL CORP
Entity type:Organization
Organization Name:KJ KIM DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DDS
Authorized Official - Prefix:
Authorized Official - First Name:KEON JUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-757-9876
Mailing Address - Street 1:2952 OCEANSIDE BLVD # 1
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4817
Mailing Address - Country:US
Mailing Address - Phone:760-757-9876
Mailing Address - Fax:
Practice Address - Street 1:2952 OCEANSIDE BLVD # 1
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4817
Practice Address - Country:US
Practice Address - Phone:760-757-9876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental