| Dr. Jeffrey J Kim's Dental, Inc. | |
|
784 N D Street San Bernardino CA 92401 | |
| (909) 884-4733 | |
| (909) 884-0668 |
| Full Name | Dr. Jeffrey J Kim's Dental, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 784 N D Street, San Bernardino, California |
| Authorized Official Name and Position | Jeffrey J Kim (OWNER) |
| Authorized Official Contact | 9098844733 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Jeffrey J Kim's Dental, Inc. 784 N D Street San Bernardino CA 92401 Ph: (909) 884-4733 | Dr. Jeffrey J Kim's Dental, Inc. 784 N D Street San Bernardino CA 92401 Ph: (909) 884-4733 |
| NPI Number | 1841316437 |
|---|---|
| Provider Enumeration Date | 03/22/2007 |
| Last Update Date | 06/29/2016 |
| Medicare PECOS PAC ID | 5092938209 |
|---|---|
| Medicare Enrollment ID | O20140515000995 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841316437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 40252 (California) | Primary |
| Provider Name | Jeffrey Kim |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1851550248 PECOS PAC ID: 3072736289 Enrollment ID: I20140515001738 |
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