| Miracle Mile Comprehensive Dental Center | |
|
5455 Wilshire Blvd Suite # 850 Los Angeles CA 90036-4201 | |
| (323) 930-4600 | |
| (323) 930-4604 |
| Full Name | Miracle Mile Comprehensive Dental Center |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5455 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Jang Wook Kim (CEO) |
| Authorized Official Contact | 3239304600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Miracle Mile Comprehensive Dental Center 5455 Wilshire Blvd Suite # 850 Los Angeles CA 90036-4201 Ph: (323) 930-4600 | Miracle Mile Comprehensive Dental Center 5455 Wilshire Blvd Suite # 850 Los Angeles CA 90036-4201 Ph: (323) 930-4600 |
| NPI Number | 1043468267 |
|---|---|
| Provider Enumeration Date | 08/29/2008 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043468267 | NPI | - | NPPES |
| D5015001 | Medicaid | CA | |
| 1801920921 | Other | CA | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5015001 (California) | Primary |
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