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Organization
MIRACLE MILE COMPREHENSIVE DENTAL CENTER
Active
Organization
MIRACLE MILE COMPREHENSIVE DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JANG WOOK KIM D.D.S. (CEO)
(323) 930-4600
Entity
Organization
Contact information
Practice address
5455 WILSHIRE BLVD, SUITE # 850, LOS ANGELES, CA 90036-4201
(323) 930-4600
(323) 930-4604
Mailing address
5455 WILSHIRE BLVD, SUITE # 850, LOS ANGELES, CA 90036-4201
(323) 930-4600
(323) 930-4604
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5015001
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1801920921
INDIVIDUAL NPI
CA
05
—
D5015001
—
CA
Enumeration date
08/29/2008
Last updated
03/07/2023
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