Provider Demographics
NPI:1962549519
Name:GAMINCHI AND KIM DENTAL CORPORATION
Entity type:Organization
Organization Name:GAMINCHI AND KIM DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-944-4745
Mailing Address - Street 1:15651 IMPERIAL HWY STE 105
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1600
Mailing Address - Country:US
Mailing Address - Phone:562-944-4745
Mailing Address - Fax:
Practice Address - Street 1:15651 IMPERIAL HWY STE 105
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1600
Practice Address - Country:US
Practice Address - Phone:562-944-4745
Practice Address - Fax:562-944-4745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA439941223G0001X
CA548131223G0001X
CA414071223P0300X
CA452381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty