| Premiere Dental Care | |
|
3680 Wilshire Blvd Ste 210 Los Angeles CA 90010-2713 | |
| (213) 739-8855 | |
| (213) 739-8899 |
| Full Name | Premiere Dental Care |
|---|---|
| Speciality | Dentist |
| Location | 3680 Wilshire Blvd Ste 210, Los Angeles, California |
| Authorized Official Name and Position | Min Seok Kim (PRESIDENT) |
| Authorized Official Contact | 2132492319 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premiere Dental Care 3680 Wilshire Blvd Ste 210 Los Angeles CA 90010-2713 Ph: (213) 739-8855 | Premiere Dental Care 3680 Wilshire Blvd Ste 210 Los Angeles CA 90010-2713 Ph: (213) 739-8855 |
| NPI Number | 1578736872 |
|---|---|
| Provider Enumeration Date | 04/08/2008 |
| Last Update Date | 04/12/2019 |
| Medicare PECOS PAC ID | 4880837608 |
|---|---|
| Medicare Enrollment ID | O20130827000418 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578736872 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 54166 (California) | Primary |
| Provider Name | Min Seok Kim |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1427218619 PECOS PAC ID: 4486897212 Enrollment ID: I20130827000474 |
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