Provider Demographics
NPI:1194273102
Name:ANNE S. KIM DDS, INC.
Entity type:Organization
Organization Name:ANNE S. KIM DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:SOOYUN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-247-4155
Mailing Address - Street 1:19333 BEAR VALLEY RD STE 205
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-5150
Mailing Address - Country:US
Mailing Address - Phone:760-247-4155
Mailing Address - Fax:760-247-4955
Practice Address - Street 1:19333 BEAR VALLEY RD STE 205
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-5150
Practice Address - Country:US
Practice Address - Phone:760-247-4155
Practice Address - Fax:760-247-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA555361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty