Healthcare Provider Details

I. General information

NPI: 1740016559
Provider Name (Legal Business Name): DR. SOON NO KIM DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 SEPULVEDA BLVD
TORRANCE CA
90505-2952
US

IV. Provider business mailing address

2724 SEPULVEDA BLVD
TORRANCE CA
90505-2952
US

V. Phone/Fax

Practice location:
  • Phone: 310-539-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SOON NO KIM
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 213-500-4509