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General NPI Number Information
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NPI Number | 1568940427
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Entity Type | Individual
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Provider Name | HEIDI WEIZHANG KIM DDS
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Gender | Female
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 906 S SUNSET AVE STE 105
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City | WEST COVINA
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State | CA
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Zip | 91790-3400
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Country | US
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Telephone | 626-480-1543
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Fax |
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Provider Business Mailing Address
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Address Line | 3712 AVENUE SAUSALITO
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City | IRVINE
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State | CA
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Zip | 92606-1849
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Country | US
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Telephone | 202-701-0602
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 106286
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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