Healthcare Provider Details

I. General information

NPI: 1215184072
Provider Name (Legal Business Name): BRIAN D KIM DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12721 NEWPORT AVE STE 1
TUSTIN CA
92780-8031
US

IV. Provider business mailing address

12721 NEWPORT AVE STE 1
TUSTIN CA
92780-8031
US

V. Phone/Fax

Practice location:
  • Phone: 714-730-8070
  • Fax: 714-730-8112
Mailing address:
  • Phone: 714-730-8070
  • Fax: 714-730-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number50765
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: BRIAN KIM
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 714-730-8070