Provider Demographics
NPI:1861208738
Name:HAN S. KIM D.D.S. INC.
Entity type:Organization
Organization Name:HAN S. KIM D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAN
Authorized Official - Middle Name:SUNG
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-483-0600
Mailing Address - Street 1:7333 HELLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1302
Mailing Address - Country:US
Mailing Address - Phone:909-483-0600
Mailing Address - Fax:909-483-0669
Practice Address - Street 1:7333 HELLMAN AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1302
Practice Address - Country:US
Practice Address - Phone:909-483-0600
Practice Address - Fax:909-483-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental