=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013492438
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOJEONG KIM DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2018
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1647 ADMIRAL TAUSSIG BLVD
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23511-2803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-953-8575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24700 CALAROGA AVE STE 104
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94545-2160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-785-9295
-----------------------------------------------------
Fax | 510-785-9412
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 102573
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------