Provider Demographics
NPI:1962919571
Name:GITAE KIM DENTAL GROUP INC
Entity type:Organization
Organization Name:GITAE KIM DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GITAE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-384-2864
Mailing Address - Street 1:3054 W 8TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1895
Mailing Address - Country:US
Mailing Address - Phone:213-384-2864
Mailing Address - Fax:213-384-2386
Practice Address - Street 1:3054 W 8TH ST STE 106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1895
Practice Address - Country:US
Practice Address - Phone:213-384-2864
Practice Address - Fax:213-384-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58750261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental