| Prime Dental Group Dr Kim | |
|
13252 Century Blvd Ste Q Garden Grove CA 92843-1257 | |
| (714) 591-5190 | |
| Not Available |
| Full Name | Prime Dental Group Dr Kim |
|---|---|
| Speciality | Clinic/Center |
| Location | 13252 Century Blvd Ste Q, Garden Grove, California |
| Authorized Official Name and Position | Seung Hwan Kim (OWNER) |
| Authorized Official Contact | 2135052088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Dental Group Dr Kim 13252 Century Blvd Ste Q Garden Grove CA 92843-1257 Ph: (714) 591-5190 | Prime Dental Group Dr Kim 13252 Century Blvd Ste Q Garden Grove CA 92843-1257 Ph: (714) 591-5190 |
| NPI Number | 1689198806 |
|---|---|
| Provider Enumeration Date | 07/30/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 2567717416 |
|---|---|
| Medicare Enrollment ID | O20180616000005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689198806 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 65350 (California) | Primary |
| Provider Name | Seung Hwan Kim |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1972964260 PECOS PAC ID: 3476808320 Enrollment ID: I20180616000031 |
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