| Smile Dental & Implant Center | |
|
1055 S. Alvarado St Los Angeles CA 90004 | |
| (213) 382-8980 | |
| (213) 382-5159 |
| Full Name | Smile Dental & Implant Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1055 S. Alvarado St, Los Angeles, California |
| Authorized Official Name and Position | Dong M Kim (C.E.O) |
| Authorized Official Contact | 2133828980 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Smile Dental & Implant Center 1055 S. Alvarado St Los Angeles CA 90004 Ph: (213) 382-8980 | Smile Dental & Implant Center 1055 S. Alvarado St Los Angeles CA 90004 Ph: (213) 382-8980 |
| NPI Number | 1487926911 |
|---|---|
| Provider Enumeration Date | 01/30/2012 |
| Last Update Date | 01/30/2012 |
| Medicare PECOS PAC ID | 9537445523 |
|---|---|
| Medicare Enrollment ID | O20170405000964 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487926911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 55265 (California) | Primary |
| Provider Name | Dong Kim |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1821203282 PECOS PAC ID: 6204148802 Enrollment ID: I20170405001069 |
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