Healthcare Provider Details

I. General information

NPI: 1437417391
Provider Name (Legal Business Name): ROY H KIM D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26720 TOWNE CENTRE DR STE B
FOOTHILL RANCH CA
92610-2840
US

IV. Provider business mailing address

26720 TOWNE CENTRE DR STE B
FOOTHILL RANCH CA
92610-2840
US

V. Phone/Fax

Practice location:
  • Phone: 949-830-2003
  • Fax: 949-830-2017
Mailing address:
  • Phone: 949-830-2003
  • Fax: 949-830-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number64548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: