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General NPI Number Information
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NPI Number | 1215456041
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Entity Type | Individual
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Provider Name | SEAN SANGHO KIM DDS
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Gender | Male
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 2711 SANTA ANA ST
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City | SOUTH GATE
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State | CA
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Zip | 90280-2021
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Country | US
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Telephone | 323-277-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 165 S LAS PALMAS AVE
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City | LOS ANGELES
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State | CA
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Zip | 90004-1049
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Country | US
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Telephone | 213-448-0333
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 103362
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License Number State | CA
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