Healthcare Provider Details

I. General information

NPI: 1902463821
Provider Name (Legal Business Name): JIN SEOK KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2019
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LOMITA BLVD STE 406
TORRANCE CA
90505-4991
US

IV. Provider business mailing address

350 N CLARK ST STE 600 C/O KOS SERVICES, ATTN: HR
CHICAGO IL
60654-4782
US

V. Phone/Fax

Practice location:
  • Phone: 310-347-7788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number103932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: