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General NPI Number Information
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NPI Number | 1306323035
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Entity Type | Organization
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Legal Business Name | SEAN KIM, DDS, INC.
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Dates
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Enumeration Date | 07/25/2018
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 1213 N LAKE AVE
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City | PASADENA
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State | CA
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Zip | 91104-3768
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Country | US
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Telephone | 626-584-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 936 CRENSHAW BLVD STE 101
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City | LOS ANGELES
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State | CA
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Zip | 90019-1948
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SEAN SUNYOTO
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Credential | DDS
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Telephone | 626-510-2606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 102689
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License Number State | CA
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