Provider Demographics
NPI:1588979744
Name:KIM, JOEL CHUL JU (DDS)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:CHUL JU
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 1:8485 TAMARIND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3975
Mailing Address - Country:US
Mailing Address - Phone:909-356-6852
Mailing Address - Fax:
Practice Address - Street 1:8485 TAMARIND AVE STE A
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3975
Practice Address - Country:US
Practice Address - Phone:909-356-6852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist