Healthcare Provider Details

I. General information

NPI: 1609711605
Provider Name (Legal Business Name): T.KIM DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 APPIAN WAY STE 303
PINOLE CA
94564-2525
US

IV. Provider business mailing address

2000 APPIAN WAY STE 303
PINOLE CA
94564-2525
US

V. Phone/Fax

Practice location:
  • Phone: 510-964-0168
  • Fax: 510-964-0908
Mailing address:
  • Phone: 510-964-0168
  • Fax: 510-964-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TERI L KIM
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 916-792-9267