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General NPI Number Information
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NPI Number | 1437523883
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Entity Type | Organization
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Legal Business Name | SUNG KOO KIM,DDS,INC.
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 18887 COLIMA RD
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-2940
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Country | US
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Telephone | 626-810-8826
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Fax |
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Provider Business Mailing Address
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Address Line | 2266 NORTE VISTA DR
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City | CHINO HILLS
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State | CA
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Zip | 91709-1305
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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 | CEO
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Name | MR. SUNG KOO KIM
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Credential |
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Telephone | 626-810-8826
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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 | 50764
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License Number State | CA
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