Provider Demographics
NPI:1992066435
Name:HYUNG-JU JOHN KIM DDS INC
Entity type:Organization
Organization Name:HYUNG-JU JOHN KIM DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DR. HYUNG-JU
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-387-2100
Mailing Address - Street 1:2528 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 110-111
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2922
Mailing Address - Country:US
Mailing Address - Phone:213-387-2100
Mailing Address - Fax:213-387-2103
Practice Address - Street 1:2528 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 110-111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2922
Practice Address - Country:US
Practice Address - Phone:213-387-2100
Practice Address - Fax:213-387-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty