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General NPI Number Information
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NPI Number | 1003035114
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Entity Type | Individual
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Provider Name | KWANG SEOB KIM D.D.S
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Gender | Male
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 03/15/2019
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Provider Practice Location Address
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Address Line | 18250 COLIMA RD 201
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-2602
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Country | US
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Telephone | 626-964-2875
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Fax | 626-964-1033
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Provider Business Mailing Address
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Address Line | 4022 SANTA ANITA LN
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City | YORBA LINDA
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State | CA
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Zip | 92886
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Country | US
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Telephone | 909-319-5777
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 50479
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License Number State | CA
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