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General NPI Number Information
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NPI Number | 1336546514
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Entity Type | Organization
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Legal Business Name | SUSAN HAE SUK KIM DDS INC
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 1301 S BEACH BLVD UNIT G
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City | LA HABRA
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State | CA
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Zip | 90631-6384
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Country | US
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Telephone | 951-790-7496
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 S BEACH BLVD UNIT G
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City | LA HABRA
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State | CA
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Zip | 90631-6384
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Country | US
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Telephone | 562-448-3976
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Fax |
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Authorized Official
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Title or Position | DENTIST/PRESIDENT
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Name | DR. HAE SUK KIM
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Credential | D.D.S
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Telephone | 562-448-3976
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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 | 61888
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License Number State | CA
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