| John Kim Dds, Inc | |
|
906 N. Vermont Ave. Los Angeles CA 90029-3915 | |
| (323) 522-3382 | |
| (323) 934-4787 |
| Full Name | John Kim Dds, Inc |
|---|---|
| Speciality | Dentist |
| Location | 906 N. Vermont Ave., Los Angeles, California |
| Authorized Official Name and Position | Johnny K Kim (OWNER) |
| Authorized Official Contact | 3236174180 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John Kim Dds, Inc 936 Crenshaw Blvd #100 Los Angeles CA 90019-1957 Ph: (323) 617-4180 | John Kim Dds, Inc 906 N. Vermont Ave. Los Angeles CA 90029-3915 Ph: (323) 522-3382 |
| NPI Number | 1831468362 |
|---|---|
| Provider Enumeration Date | 12/29/2011 |
| Last Update Date | 02/28/2020 |
| Medicare PECOS PAC ID | 7315208261 |
|---|---|
| Medicare Enrollment ID | O20180309002058 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831468362 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 34860 (California) | Primary |
| Provider Name | Johnny K Kim |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1528155819 PECOS PAC ID: 5597026443 Enrollment ID: I20180313001931 |
| Provider Name | Sean Sunyoto |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1124514112 PECOS PAC ID: 0749515674 Enrollment ID: I20190715000865 |
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