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General NPI Number Information
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NPI Number | 1578611356
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Entity Type | Individual
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Provider Name | KWANG JIN KIM D.D.S
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3300 W ROSECRANS AVE SUITE 105
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City | HAWTHORNE
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State | CA
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Zip | 90250-8218
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Country | US
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Telephone | 310-679-3300
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Fax | 310-679-3932
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Provider Business Mailing Address
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Address Line | 2220 SMOKEWOOD AVE
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City | FULLERTON
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State | CA
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Zip | 92831-1107
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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 |
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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 | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 31300
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License Number State | CA
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