Healthcare Provider Details

I. General information

NPI: 1386645984
Provider Name (Legal Business Name): QUY N KIM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 WARNER AVE
FOUNTAIN VALLEY CA
92708-7511
US

IV. Provider business mailing address

22 IROQUOIS CT
IRVINE CA
92602-0751
US

V. Phone/Fax

Practice location:
  • Phone: 714-549-0911
  • Fax:
Mailing address:
  • Phone: 714-573-2126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number42748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: