Provider Demographics
NPI:1528112968
Name:KIM, BOCK J (DDS)
Entity type:Individual
Prefix:MR
First Name:BOCK
Middle Name:J
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 EASTERN AVE
Mailing Address - Street 2:#B
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201
Mailing Address - Country:US
Mailing Address - Phone:323-773-2082
Mailing Address - Fax:323-560-3905
Practice Address - Street 1:6501 EASTERN AVE
Practice Address - Street 2:#B
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201
Practice Address - Country:US
Practice Address - Phone:323-773-2082
Practice Address - Fax:323-560-3905
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528112968OtherDENTICAL