Provider Demographics
NPI:1053285106
Name:MINJAE KIM DMD, INC.
Entity type:Organization
Organization Name:MINJAE KIM DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MINJAE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:510-821-5505
Mailing Address - Street 1:228 ENCOUNTER BAY
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-7909
Mailing Address - Country:US
Mailing Address - Phone:510-821-5505
Mailing Address - Fax:
Practice Address - Street 1:133 KEARNY ST STE 301
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4811
Practice Address - Country:US
Practice Address - Phone:415-989-3648
Practice Address - Fax:415-989-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty