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2801 W Ball Rd #10 Anaheim CA 92804-4900 | |
| (714) 527-5656 | |
| (714) 527-7412 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2801 W Ball Rd, Anaheim, California |
| Authorized Official Name and Position | Douglas Kim (OWNER) |
| Authorized Official Contact | 5622173382 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2801 W Ball Rd #10 Anaheim CA 92804-4900 Ph: (714) 527-5656 | 2801 W Ball Rd #10 Anaheim CA 92804-4900 Ph: (714) 527-5656 |
| NPI Number | 1952782070 |
|---|---|
| Provider Enumeration Date | 06/15/2015 |
| Last Update Date | 06/15/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952782070 | NPI | - | NPPES |
| 1083045173 | Other | CA | NPI TYPE 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 63129 (California) | Primary |
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