Healthcare Provider Details

I. General information

NPI: 1063322089
Provider Name (Legal Business Name): ALISON SOOYUNG KIM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-779 FARRINGTON HWY STE 301
WAIPAHU HI
96797-3175
US

IV. Provider business mailing address

7170 SAN CARMELA CT
RANCHO CUCAMONGA CA
91739-1874
US

V. Phone/Fax

Practice location:
  • Phone: 808-515-4222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number113672
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: