Organization
BSJC, LLC
Active
Other names
Premier Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONGSUNG KIM DDS (CEO)
(671) 300-3221
Entity
Organization
Contact information
Practice address
692 N MARINE CORPS DR STE 301, TAMUNING, GU 96913-4454
(671) 300-3221
(671) 300-3223
Mailing address
692 N MARINE CORPS DR STE 301, TAMUNING, GU 96913-4454
(671) 300-3221
(671) 300-3223
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
D1014
GU
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
Other
Enumeration date
11/29/2017
Last updated
11/29/2017
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