Healthcare Provider Details

I. General information

NPI: 1619781119
Provider Name (Legal Business Name): ALVIN H KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 CIVIC DR STE 145
WALNUT CREEK CA
94596-8229
US

IV. Provider business mailing address

1111 CIVIC DR STE 145
WALNUT CREEK CA
94596-8229
US

V. Phone/Fax

Practice location:
  • Phone: 925-937-9017
  • Fax:
Mailing address:
  • Phone: 925-937-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: