Provider Demographics
NPI:1871769109
Name:JANICE Y. PARK-KIM, D.D.S., INC.
Entity type:Organization
Organization Name:JANICE Y. PARK-KIM, D.D.S., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-368-3319
Mailing Address - Street 1:3971 IRVINE BLVD
Mailing Address - Street 2:STE. 102
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2482
Mailing Address - Country:US
Mailing Address - Phone:714-368-3319
Mailing Address - Fax:
Practice Address - Street 1:3971 IRVINE BLVD
Practice Address - Street 2:STE. 102
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-2482
Practice Address - Country:US
Practice Address - Phone:714-368-3319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA486581223P0221X
CA436171223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty